Managing demand for laboratory tests: a laboratory toolkit

  title={Managing demand for laboratory tests: a laboratory toolkit},
  author={Anthony A. Fryer and W Stuart A Smellie},
  journal={Journal of Clinical Pathology},
  pages={62 - 72}
Healthcare budgets worldwide are facing increasing pressure to reduce costs and improve efficiency, while maintaining quality. Laboratory testing has not escaped this pressure, particularly since pathology investigations cost the National Health Service £2.5 billion per year. Indeed, the Carter Review, a UK Department of Health-commissioned review of pathology services in England, estimated that 20% of this could be saved by improving pathology services, despite an average annual increase of 8… 

Laboratory demand management of repetitive testing – time for harmonisation and an evidenced based approach

  • T. Lang
  • Medicine
    Clinical chemistry and laboratory medicine
  • 2013
In partnership with hospital physicians “ spare periods ” (periods during which tests were barred) were produced and implemented through the laboratory information and management system (LIMS), and the financial savings realised were relatively low.

Managing inappropriate utilization of laboratory resources

Demand management tools are provided as a means for overcoming the issue of inappropriate utilization of laboratory tests and when based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources.

Containing costs in the era of National Health Insurance - the need for and importance of demand management in laboratory medicine.

  • T. Pillay
  • Medicine, Political Science
    South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
  • 2012
The implementation of the National Health Insurance scheme will place pathology services under increased pressure, and laboratories will have to formulate strategies to address both under- and overutilisation of laboratory tests and ensure that the proper use of clinical laboratory testing contributes to improved patient care.

Clinicians’ and laboratory medicine specialists’ views on laboratory demand management: a survey in nine European countries

The results of the survey show that tools to improve the appropriate use of laboratory tests are already regularly used today and laboratory medicine specialists as well as clinicians are willing to undertake additional shared activities aimed at improving patient-centered laboratory diagnostic workup.

Demand management by electronic gatekeeping of test requests does not influence requesting behaviour or save costs dramatically

Electronic gatekeeping was concluded not to have a substantial effect on the clinician test requesting pattern, demonstrated by the largely unchanged monthly percentage of electronic gatekeeping-held tests.

A review on laboratory tests’ utilization: A trigger for cutting costs and quality improvement in health care settings

Whereas, inappropriate test ordering was more frequent than inefficient tests, the initial improvement strategy should focus on physicians’ test ordering behavior through conducting proper teaching strategies, ongoing audit and educational feedback, implementing health information technology tools and employing laboratory practice guidelines (LPGs and testing algorithms.

Clinical need-directed blood tests: a step in saving the NHS?

The direction, by a senior clinician, of the requesting of blood tests by junior doctors to ensure that requests were based on clinical need, reduced the number of inappropriate blood tests and resulted in some reduction in laboratory costs.

Optimising laboratory monitoring of chronic conditions in primary care: a quality improvement framework

Overall primary care testing rates in North Devon fell by 14% for full blood count testing and 22% for liver function tests, but without a reduction in the number of tests showing possible significant pathology, and introduction of simple chronic disease test groups into primary care electronic ordering systems leads to both quality improvement and reduction in system costs.

Pursuing appropriateness of laboratory tests: a 15-year experience in an academic medical institution

Over the last 15 years, the medical laboratory has enforced various interventions to improve test appropriateness, all directly or indirectly based on CPOE use and it was confirmed that laboratory professionals have an irreplaceable role as “stewards” in designing, implementing, evaluating, and maintaining interventions focused to improving test Appropriateness.



Managing utilization of new diagnostic tests.

  • K. Lewandrowski
  • Medicine
    Clinical leadership & management review : the journal of CLMA
  • 2003
A perspective on approaches to laboratory test utilization is given and specific examples of initiatives undertaken are offered to illustrate how the pathologist can use knowledge of medicine and the clinical laboratory in conjunction with organizational and team building skills.

The rise and fall of C-reactive protein: managing demand within clinical biochemistry

It is demonstrated that strategies to control demand at the requesting stage have been able to reduce the number of requests from acute admission units, saving the Trust approximately £10,000 per annum.

Managing the demand for laboratory testing: options and opportunities.

  • P. Janssens
  • Medicine
    Clinica chimica acta; international journal of clinical chemistry
  • 2010

Costly regional variations in primary health care test utilization in Sweden

The inter-county variations in Sweden are large and the savings associated with optimized test utilization are substantial, and the variations are likely influenced by regional habits and traditions.

Benchmarking general practice use of pathology services: a model for monitoring change

Ranking general practitioners requesting activity adjusted for practice list size provides a reproducible means of measuring requesting activity for most pathology tests performed in general practice.

Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy

Repeated audit, continuous education and alertness of doctors, on the basis of assessment of factors contributing to laboratory overutilisation, result in restraining the redundant ordering of tests in the hospital setting.

The safety implications of missed test results for hospitalised patients: a systematic review

Evidence of the negative impacts for patients when important results are not actioned, matched with advances in the functionality of clinical information systems, presents a convincing case for the need to explore solutions.

Costs of unnecessary tests.

If a local survey in the Trent Region reflected the pattern of medical outpatient practice nationally, then pounds 1.25 million could be saved annually if routine investigation was discontinued on all patients whose problem had already been diagnosed on the basis of the history and the clinical examination.

Modifying the request behaviour of clinicians.

It is suggested that feedback of laboratory data to clinicians modifies their request behaviour and that supplying clinicians with information on what they do can influence the way they make decisions.