When I use the words “test utilization,” what comes to mind? Is it “the right test for the right patient at the right time?” Or do you perhaps think of the Choosing Wisely recommendations – 25 published to date (1) – that caution against potentially overused tests? Test utilization is more than just a buzzword. What we’re actually referencing is the opportunity to help you make laboratory testing more efficient so that your patients receive state-of-the-art testing using assays that are proven to be empirically data-driven and yield the best possible outcome. Often, that means using your expertise to drive behavioral changes both within the laboratory and throughout the entire medical system.
Within the laboratory, we’ve been practicing test utilization from day one. We study reflex protocols to find ways to save money while maintaining test quality and patient safety. We refine test menus by discontinuing old or inefficient methodologies. We also determine which tests can be performed in-house and which ones should be sent to a reference laboratory. We educate our staff so they’re up-to-date on the latest methodologies and gold standards. We develop our own laboratory tests to better serve our patient populations. We analyze internal data and benchmarks to find inappropriate test-ordering practices so that they can be rectified through education. Although these daily tasks are important, educational activities for clinical staff outside the laboratory could have the biggest impact.
It can be as simple as designing a paper requisition that’s easy to read and understand, making test ordering easier. Or we can go a little bit more in-depth by working with our institutions’ IT departments to implement reminders within the electronic ordering system, ideally reducing redundant test orders and enabling clinicians to order the right test for their situation the first time.
We also have several opportunities for a more personal approach. We can consult with an ordering physician about patient results and discuss the best follow-up diagnostics. Giving presentations to clinicians can help them order the right tests for their specific situations. And we can discuss the utility of ordering morning labs each day for an inpatient whose condition has not changed – or who is leaving the hospital that day.
As pathologists and laboratory professionals, we have an obligation to provide excellent patient care as efficiently as possible. So “test utilization” is far more than just a buzzword – it’s the essence of what we do.
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References
- Choosing Wisely, “American Society for Clinical Pathology” (2018). Available at: https://bit.ly/2iWd1ec. Accessed November 20, 2018.