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.
