Podolsky Eyal, Hudek Natasha, McCleary Nicola, McCudden Christopher, Presseau Justin, Brehaut Jamie C
Centre for Practice Changing Research, Ottawa Hospital Research Institute, Methodological and Implementation Research (MIR) Program, The Ottawa Hospital, General Campus, Ottawa, ON, Canada.
Child Health Evaluative Sciences Program, The Hospital for Sick Children - Research Institute, Toronto, ON, Canada.
Clin Chem Lab Med. 2024 Sep 23;63(3):545-551. doi: 10.1515/cclm-2024-0948. Print 2025 Feb 25.
Lab testing is a high-volume activity that is often overused, leading to wasted resources and inappropriate care. Improving test ordering practices in tertiary care involves deciding where to focus scarce intervention resources, but clear guidance on how to optimize these resources is lacking. We aimed to explore context-sensitive factors and processes that inform individual decisions about laboratory stewardship interventions by speaking to key interest holders in this area.
We conducted semi-structured interviews with test-ordering intervention development experts and authors of test-ordering guidance documents to explore five broad topics: 1) processes used to prioritize tests for intervention; 2) factors considered when deciding which tests to target; 3) measurement of these factors; 4) interventions selected; 5) suggestions for a framework to support these decisions. Transcripts were double coded using directed-content and thematic analysis.
We interviewed 14 intervention development experts. Experts noted they frequently consider test volume, test value, and patient care when deciding on a test to target. Experts indicated that quantifying many relevant factors was challenging. Processes to support these decisions often involved examining local data, obtaining buy-in, and relying on an existing guideline. Suggestions for building a framework emphasized the importance of collaboration, consideration of context and resources, and starting with "easy wins" to gain support and experience.
Our study provides insight into the factors and processes experts consider when deciding which tests to target for intervention and can inform the development of a framework to guide the selection of tests for intervention and guideline development.
实验室检测是一项量大的活动，常常被过度使用，导致资源浪费和不恰当的医疗护理。改善三级医疗中的检测医嘱开具行为涉及决定将稀缺的干预资源集中于何处，但缺乏关于如何优化这些资源的明确指导。我们旨在通过与该领域的关键利益相关者交流，探索影响实验室管理干预个体决策的情境敏感因素和过程。
我们对检测医嘱开具干预开发专家和检测医嘱开具指导文件的作者进行了半结构化访谈，以探讨五个广泛的主题：1）用于确定干预检测优先级的过程；2）决定针对哪些检测时考虑的因素；3）这些因素的衡量；4）选择的干预措施；5）对支持这些决策的框架的建议。使用定向内容分析和主题分析对访谈记录进行双重编码。
我们采访了14位干预开发专家。专家指出，他们在决定针对某项检测时经常会考虑检测量、检测价值和患者护理。专家表示，量化许多相关因素具有挑战性。支持这些决策的过程通常包括审查本地数据、获得认可并依赖现有指南。构建框架的建议强调了合作、考虑情境和资源以及从“轻松获胜”入手以获得支持和经验的重要性。
我们的研究深入了解了专家在决定针对哪些检测进行干预时考虑的因素和过程，并可为指导干预检测选择和指南制定的框架的开发提供参考。
