Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries
-
Mercedes Ibarz
,
Janne Cadamuro
,
Zorica Sumarac
Abstract
Background
Laboratory tests are an essential aspect of current medical practice and their use has grown exponentially. Several studies however have demonstrated inappropriate use of laboratory testing. This inappropriateness can lead to delayed or wrong diagnosis, negatively impacting patient safety and an increase in health care expenditure. The aim of the present small-scale survey was to obtain information on the current status of demand management in European laboratories, as well as the opinions of laboratory and clinical professionals in this regard.
Methods
Two surveys were developed, one for laboratory specialists and one for clinicians, covering information on current use, knowledge and opinions on the possible impact of different demand management strategies on patient outcome and health care costs. Additionally, we asked for the current state and willingness on collaboration of laboratory specialists and clinicians.
Results
One hundred and fifty responses, 72 laboratory specialists and 78 clinicians, from nine countries were received. Developing local ordering protocols/profiles in collaboration with clinicians was the most used strategy (80.3% of laboratories). Of clinicians, 85.6% considered measures to ensure appropriate use of tests necessary and 100% were interested in advice/information about their indication. Of the laboratory specialists 97.2% were either already participating or willing to participate in multidisciplinary groups on the appropriateness of test demand as were 60.3% of clinicians, and 85.9% of clinicians were interested in attending activities about laboratory test demand management.
Conclusions
The results of our survey show that tools to improve the appropriate use of laboratory tests are already regularly used today. Laboratory medicine specialists as well as clinicians are willing to undertake additional shared activities aimed at improving patient-centered laboratory diagnostic workup.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: 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.
References
1. Barletta G, Zaninotto M, Faggian D, Plebani M. Shop for quality or quantity?. Volumes and costs in clinical laboratories. Clin Chem Lab Med 2013;51:295–301.10.1515/cclm-2012-0415Search in Google Scholar PubMed
2. Lippi G, Bovo C, Ciaccio M. Inappropriateness in laboratory medicine: an elephant in the room? Ann Transl Med 2017;5:82–82.10.21037/atm.2017.02.04Search in Google Scholar PubMed PubMed Central
3. Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One 2013;8:1–8.10.1371/journal.pone.0078962Search in Google Scholar PubMed PubMed Central
4. Catrou PG. Is that lab test necessary? Am J Clin Pathol 2006;126:335–6.10.1309/7QF325U565PMP8U5Search in Google Scholar
5. Cadamuro J, Gaksch M, Wiedemann H, Lippi G, von Meyer A, Pertersmann A, et al. Are laboratory tests always needed? Frequency and causes of laboratory overuse in a hospital setting. Clin Biochem 2018;54:85–91.10.1016/j.clinbiochem.2018.01.024Search in Google Scholar PubMed
6. Rao G CMTM. Pathology tests: is the time for demand management ripe at last? J Clin Pathol 2003;56:243–8.10.1136/jcp.56.4.243Search in Google Scholar PubMed PubMed Central
7. Van Walraven CNC. Do we know what inappropriate laboratory utilization is? J Am Med Assoc Intern Med 1998;12:550–8.10.1001/jama.280.6.550Search in Google Scholar PubMed
8. Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 2006;145:488–96.10.7326/0003-4819-145-7-200610030-00006Search in Google Scholar PubMed
9. Schiff GD, Hasan O, Kim S, Abrams R, Cosby K, Lambert BL, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med 2009;169:1881–7.10.1001/archinternmed.2009.333Search in Google Scholar PubMed
10. Slawomirski L, Auraaen A KN. The economics of patient safety – strengthening a value-based approach to reducing patient harm at national level: Organisation for Economic Co-operation and Development – OECD; 2017 [15th Jan. 2018]. [Internet]. 2018. Available from: https://www.oecd.org/els/health-systems/The-economics-of-patient-safety-March-2017.pdf.Search in Google Scholar
11. Cadamuro J, Ibarz M, Cornes M, Nybo M, Haschke-Becher E, von Meyer A, et al. Managing inappropriate utilization of laboratory resources. Diagnosis 2019;6:5–13.10.1515/dx-2018-0029Search in Google Scholar PubMed
12. Smellie WS. Demand management and test request rationalization. Ann Clin Biochem 2012;49:323–36.10.1258/acb.2011.011149Search in Google Scholar PubMed
13. Fryer AA, Hanna FW. Managing demand for pathology tests: financial imperative or duty of care? Ann Clin Biochem 2009;46:435–7.10.1258/acb.2009.009186Search in Google Scholar PubMed
14. Fryer AA, Smellie WS. Managing demand for laboratory tests: a laboratory toolkit. J Clin Pathol 2013;66:62–72.10.1136/jclinpath-2011-200524Search in Google Scholar PubMed
15. Janssens PM. Managing the demand for laboratory testing: options and opportunities. Clin Chim Acta 2010;411:1596–602.10.1016/j.cca.2010.07.022Search in Google Scholar PubMed
16. Laposata ME, Laposata M, Van Cott Em, Buchner DS, Kashalo MS, Dighe AS. Physician survey of a laboratory medicine interpretive service and evaluation of the influence of interpretations on laboratory test ordering. Arch Pathol Lab Med 2004;128:1424–7.10.5858/2004-128-1424-PSOALMSearch in Google Scholar PubMed
17. Morgan S, Van Driel M, Coleman J, Magin P. Rational test ordering in family medicine. Can Fam Physician 2015;61: 535–7.Search in Google Scholar
18. Salinas M, López-Garrigós M, Asencio A, Leiva-Salinas M, Lugo J, Leiva-Salinas C. Laboratory utilization improvement through a computer-aided algorithm developed with general practitioners. Clin Chem Lab Med 2015;53:1391–7.10.1515/cclm-2014-0762Search in Google Scholar PubMed
19. Smellie WS. Association for Clinical Biochemistry’s Clinical Practice Section. Time to harmonise common laboratory test profiles. Br Med J 2012;344:e1169.10.1136/bmj.e1169Search in Google Scholar PubMed
20. Fralick M, Hicks LK, Chaudhry H, Goldberg N, Ackery A, Nisenbaum R, et al. REDucing Unnecessary Coagulation Testing in the Emergency Department (REDUCED). Br Med J Qual Improv Rep 2017;6:u221651.w8161.10.1136/bmjquality.u221651.w8161Search in Google Scholar PubMed PubMed Central
21. Main C, Moxham T, Wyatt JC, Kay J, Anderson R, Stein K. Computerised decision support systems in order communication for diagnostic, screening or monitoring test ordering: systematic reviews of the effects and cost-effectiveness of systems. Health Technol Assess (Rockv) 2010;14:1–227.10.3310/hta14480Search in Google Scholar PubMed
22. Martins CMS, Da Costa Teixeira AS, De Azevedo LFR, Sá LMB, Santos PAAP, do Couto MLGD, et al. The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests – a randomized controlled trial. BMC Med Inform Decis Mak 2017;17:1–11.10.1136/bmjebm-2018-111070.17Search in Google Scholar
23. Lippi G, Brambilla M, Bonelli P, Aloe R, Balestrino A, Nardelli A, et al. Effectiveness of a computerized alert system based on re-testing intervals for limiting the inappropriateness of laboratory test requests. Clin Biochem 2015;48:1174–6.10.1016/j.clinbiochem.2015.06.006Search in Google Scholar PubMed
24. Krasowski MD, Chudzik D, Dolezal A, Steussy B, Gailey MP, Koch B, et al. Promoting improved utilization of laboratory testing through changes in an electronic medical record: experience at an academic medical center. BMC Med Inform Decis Mak 2015;15:11.10.1186/s12911-015-0137-7Search in Google Scholar PubMed PubMed Central
25. Poley MJ, Edelenbos KI, Mosseveld M, van Wijk MA, de Bakker DH, van der Lei J, et al. Cost consequences of implementing an electronic decision support system for ordering laboratory tests in primary care: evidence from a controlled prospective study in the Netherlands. Clin Chem 2007;53:213–9.10.1373/clinchem.2006.073908Search in Google Scholar PubMed
26. Rubinstein M, Hirsch R, Bandyopadhyay K, Madison B, Taylor T, Ranne A, et al. Effectiveness of practices to support appropriate laboratory test utilization. Am J Clin Pathol 2018;149:197–221.10.1093/ajcp/aqx147Search in Google Scholar PubMed PubMed Central
27. The Association for Clinical Biochemistry and Laboratory Medicine. National minimum retesting interval project: a final report detailing consensus recommendations for minimum retesting intervals for use in clinical biochemistry. Available at: http://www.acb.org.uk/docs/default-source/guidelines/acb-mri-recommendations-a4-computer.pdf. Accessed 20 Aug 2019.Search in Google Scholar
28. May TA, Clancy M, Critchfield J, Ebeling F, Enriquez A, GallagherC, et al. Reducing unnecessary inpatient laboratory testing in a teaching hospital. Am J Clin Pathol 2006;126:200–6.10.1309/WP59YM73L6CEGX2FSearch in Google Scholar
29. Plebani M, Zaninotto M, Faggian D. Utilization management: a European perspective. Clin Chim Acta 2014;427:137–41.10.1016/j.cca.2013.03.002Search in Google Scholar PubMed
30. Larsson A, Palmer M, Hulten G, Tryding N. Wide variations among hospitals in use of laboratory tests. Information and education to increase cost-effectiveness. Lakartidningen 2000;97:4300, 4303–8, 4310.Search in Google Scholar
31. Elnenaei MO, Campbell SG, Thoni AJ, Lou A, Crocker BD, Nassar BA. An effective utilization management strategy by dual approach of influencing physician ordering and gate keeping. Clin Biochem 2016;49:208–12.10.1016/j.clinbiochem.2015.11.005Search in Google Scholar PubMed
32. Plebani M. Towards a new paradigm in laboratory medicine: the five rights. Clin Chem Lab Med 2016;54:1881–91.10.1515/cclm-2016-0848Search in Google Scholar PubMed
33. Watson ID, Wilkie P, Hannan A, Beastall GH. Role of laboratory medicine in collaborative healthcare. Clin Chem Lab Med 2019;57:134–42.10.1515/cclm-2017-0853Search in Google Scholar PubMed
34. Plebani M, Laposata M, Lippi G. A manifesto for the future of laboratory medicine professionals. Clin Chim Acta 2019;489:49–52.10.1016/j.cca.2018.11.021Search in Google Scholar PubMed
Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2019-0081).
©2020 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Editorial
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- Review
- Updated overview on the interplay between obesity and COVID-19
- Mini Review
- Challenges and opportunities for integrating genetic testing into a diagnostic workflow: heritable long QT syndrome as a model
- Opinion Papers
- Making sense of rapid antigen testing in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostics
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- Predicting mortality with cardiac troponins: recent insights from meta-analyses
- Guidelines and Recommendations
- Operational measurement of diagnostic safety: state of the science
- Original Articles
- Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the “Big Three”
- Pyoderma gangrenosum underrepresentation in non-dermatological literature
- Assessing the utility of a differential diagnostic generator in UK general practice: a feasibility study
- Assessing physical examination skills using direct observation and volunteer patients
- Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries
- Letters to the Editor
- Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study
- Letter in response to Vanstone paper on diagnostic intuition
- Corrigenda
- Corrigendum to: Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers
- Clinical problem solving and social determinants of health: a descriptive study using unannounced standardized patients to directly observe how resident physicians respond to social determinants of health
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