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Laboratory utilization improvement through a computer-aided algorithm developed with general practitioners

  • Maria Salinas EMAIL logo , Maite López-Garrigós , Alberto Asencio , Maria Leiva-Salinas , Javier Lugo and Carlos Leiva-Salinas
Published/Copyright: December 2, 2014
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 53 Issue 9

Abstract

Background: One of the main duties of healthcare workers is to get an appropriate use of diagnostic and therapeutic tools. The aim of this study was to show how strategies can be designed and established in consensus with general practitioners (GPs) to reach an optimal laboratory test request.

Methods: The laboratory serves a population of approximately 235,000 inhabitants, including nine primary care centers. GPs could request every test in profiles and individually. In meetings between the laboratory and GPs our request patterns were compared to other geographic regions, and we investigated the appropriateness of test requesting. The group devised strategies that consisted of removing tests from profiles [aspartate aminotransferase (AST), γ-glutamyltranspeptidase (GGT) and phosphate], removing tests from GPs requests (iron and transferrin), substituting tests (IgA antigliadin antibody), and measuring total bilirubin (tBil) only when the icteric index value was above 34.2 mmol/L (2 mg/dL). We analyzed every test request in the post- (years 2012–2013) and pre-intervention period (years 2010–2011), and the tBil measured in the post-intervention period. We studied if AST/alanine aminotransferase (ALT) and GGT/ALT achieved indicators targets and calculated the economic savings in the post-intervention period.

Results: There was a significant drop in every test request in the post-intervention period. AST/ALT achieved the indicator target. GGT/ALT, never achieved the indicator goal. The strategies resulted in a savings of more than €34,000.

Conclusions: The strategies designed between the laboratory and the requesting clinicians and automatically established by using our laboratory information system were successful.

Keywords: costs; laboratory tests utilization; outcome results; patient safety; primary care; test request appropriateness
Corresponding author: Dra. Maria Salinas, Clinical Laboratory, Hospital Universitario de San Juan, Carretera Alicante-Valencia, s/n, 03550 San Juan de Alicante, Alicante, Spain, Phone: +34 965938877, Fax: +34 965938383, E-mail: ; and Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain

Acknowledgments

The authors would like to express their deep gratitude to Professor David E. Bruns for his valuable and constructive suggestions during the review of this paper.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Financial support: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2014-7-24
Accepted: 2014-10-22
Published Online: 2014-12-2
Published in Print: 2015-8-1

©2015 by De Gruyter

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  2. Editorial
  3. New trends in the long and puzzling history of HbA1c
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  6. Opinion Paper
  7. Possible role of fructosamine 3-kinase genotyping for the management of diabetic patients
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  33. Letters to the Editors
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https://doi.org/10.1515/cclm-2014-0762
Keywords for this article
costs; laboratory tests utilization; outcome results; patient safety; primary care; test request appropriateness

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. New trends in the long and puzzling history of HbA1c
  4. Review
  5. Thyroglobulin measurement by highly sensitive assays: focus on laboratory challenges
  6. Opinion Paper
  7. Possible role of fructosamine 3-kinase genotyping for the management of diabetic patients
  8. EFLM Original Article
  9. Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)
  10. Genetics and Molecular Diagnostics
  11. Quantitative-fluorescent-PCR versus full karyotyping in prenatal diagnosis of common chromosome aneuploidies in southern Spain
  12. HIF1A and MIF as potential predictive mRNA biomarkers of pre-eclampsia: a longitudinal prospective study in high risk population
  13. General Clinical Chemistry and Laboratory Medicine
  14. Evidence of Crohn’s disease-related anti-glycoprotein 2 antibodies in patients with celiac disease
  15. Myocardial interleukin-6 in the setting of left ventricular mechanical assistance: relation with outcome and C-reactive protein
  16. Different methods to estimate serum free cortisol: a comparison during cortisol tetracosactide testing
  17. Automated immunoassays for the autoantibodies to carbamylated or citrullinated telopeptides of type I and II collagens
  18. Relevance of correction for drift and day-to-day variation in cystatin C measurement: a post-hoc analysis of the PREVEND cohort, with independent replication in the ESTHER cohort
  19. Laboratory utilization improvement through a computer-aided algorithm developed with general practitioners
  20. Quantitation of 1α,25-dihydroxyvitamin D by LC-MS/MS using solid-phase extraction and fixed-charge derivitization in comparison to immunoextraction
  21. Reference Values and Biological Variations
  22. Establishment of trimester-specific thyroid stimulating hormone and free thyroxine reference interval in pregnant Chinese women using the Beckman Coulter UniCel™ DxI 600
  23. Cancer Diagnostics
  24. Expression of vascular endothelial factor-A, gelatinases (MMP-2, MMP-9) and TIMP-1 in uterine leiomyomas
  25. Influence of ABO type on global coagulation assay results: effect of coagulation factor VIII
  26. Diabetes
  27. Benchmarking by HbA1c in a national diabetes quality register – does measurement bias matter?
  28. Comparing HbA1c, fasting and 2-h plasma glucose for screening for abnormal glucose regulation in patients undergoing coronary angiography
  29. Erroneous HbA1c measurements in the presence of β-thalassemia and common Chinese hemoglobin variants
  30. Using the likelihood ratio to evaluate allowable total error – an example with glycated hemoglobin (HbA1c)
  31. Two novel haemoglobin variants that affect haemoglobin A1c measurement by ion-exchange chromatography
  32. Analytical performances of the D-100TM hemoglobin testing system (Bio-Rad) for HbA1c assay
  33. Letters to the Editors
  34. Glycation rate of haemoglobins S, C, D, E, J and G, and analytical interference on the measurement of HbA1c with affinity chromatography and capillary electrophoresis
  35. Hemoglobin Valme HBB:c.124T>G: a new hemoglobin variant with diminished oxygen affinity causes interference in hemoglobin A1c measurement in an automated ion-exchange HPLC method
  36. Hemoglobin A1c reported in units and diagnostic cut-offs in relation to the international recommendations
  37. Hemoglobin measurements in samples containing hemoglobin-based oxygen carriers
  38. Serologic false-positive reactions for syphilis in children of allergic purpura
  39. Exploration of the pre-analytical stability of β-lactam antibiotics in plasma and blood – implications for therapeutic drug monitoring and pharmacokinetic studies
  40. Fungal contamination of hyaluronidase solution mimicking fungal joint infection: a preanalytical pitfall in synovial fluid analysis
  41. Stroke and inherited thrombophilia in a Tunisian girl with sickle cell anemia
  42. Faecal haemoglobin concentrations do vary across geography as well as with age and sex: ramifications for colorectal cancer screening
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