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Environmental Interventions to Reduce Unnecessary Lab Test Orders

Below is a list of environmental interventions that have been proven to reduce the number of unnecessary laboratory tests.

Test requisition redesign – electronic and paper

  • Restrict lab menu on inpatient order entry system
  • Preferred tests & cascades emphasized
  • Outmoded tests less obvious or deleted
  • Minimize bundles of tests for ordering convenience
  • Limit inclusion of esoteric tests on general requisitions
  • Review test naming conventions and order of appearance
  • Provide useful for information with name of test such as hCG pregnancy vs tumor marker
  • Organize tests by ordering pattern or disease state, not alphabetically

Order entry prompts

  • Clinical indications at time of ordering
  • Warning of overlapping test orders such as CMP and liver profile
  • Limit test order frequency per admission
  • Notify physician of previous results
  • Tailor ordering by physician specialty
  • Prohibit automatic ordering of daily test orders
  • Notify of tests restricted to outpatients, thrombophilia, genetics
  • Prohibit reordering of once in a lifetime test & show previous result
  • Notification that Test X only orderable by specialist
  • Require clinical information such as symptoms or exposure history
  • Display cost or relative cost of tests in electronic order entry

Algorithms & test ordering guidelines

  • Work best if lab driven since physicians will not follow results and order tests sequentially
  • Lab driven where initial results drive subsequent selection. Examples include test cascades such as thrombophilia, celiac, HCV and HIV
  • Pathologist driven where path review determines next steps. Examples include flow cytometry and  bone marrow examination
  • Genetic counselor driven when a consult is required before a genetic test can be ordered
  • List diseases and recommended tests in ordering system

Lab Performance

  • Review lab tests included in order sets and clinical guidelines
  • Optimized testing and reporting
  • Rapid TAT
  • Minimal number of laboratory errors
  • Clear, concise integrated reports with interpretive comments
  • Immediate and easy access to test results
  • Merged inpatient and outpatient test results

In the next blog specific examples of administrative interventions will be discussed. 


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