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A cost-effective method for reducing the volume of laboratory tests in a university-associated teaching hospital
Malka Attali1, Yosef Barel, Marina Somin
1Department of Internal Medicine C, Kaplan Medical Center, Rehovot 76100 Israel.
Insights
Implementing a physician-led intervention significantly reduced laboratory test orders and costs. This approach saved nearly $2 million without compromising diagnostic accuracy or patient care.
Area of Science:
- Health Economics
- Clinical Laboratory Science
- Medical Practice Management
Background:
- Laboratory testing constitutes a substantial component of hospital expenses.
- Previous efforts to curtail laboratory test utilization have yielded inconsistent outcomes.
Purpose of the Study:
- To evaluate the impact of a physician-driven, form-based system for ordering laboratory tests.
- To assess the intervention's effect on laboratory resource utilization and diagnostic precision.
Main Methods:
- A 3-year intervention was implemented in one Internal Medicine department, requiring specific physician requests for unbundled tests under senior supervision.
- Control departments maintained traditional blood test ordering methods.
- Physicians received education on the economic implications of laboratory testing.
Main Results:
- The number of tests per admission decreased from 1.91 to approximately 0.78 over three years.
- A total of 97,365 fewer tests were performed, resulting in savings of $1,914,149.
- No significant differences were observed in readmission rates or the diagnosis of conditions reliant on blood tests.
Conclusions:
- The developed intervention successfully achieved significant and sustained reductions in laboratory test orders.
- The study demonstrated substantial financial savings without adverse effects on diagnostic capabilities or patient care.
Background:
Laboratory tests comprise a significant portion of hospital expenditure. Attempts to reduce their use have had mixed results.
Objective:
To investigate the effect of an intervention based on a simple form-based system for ordering laboratory tests by physicians, on both use of laboratory resources and diagnostic accuracy.
Design:
At Kaplan Medical Center in Rehovot , Israel , there are 4 similar Internal Medicine departments. In one department (C), the new system was initiated, whereas in the other 3 departments (A, B and D), the traditional method of ordering blood tests was continued. The intervention used was a requirement for tests to be specifically requested by residents following unbundling of test panels, with hands-on supervision by a senior physician. In addition, the residents attended a series of lectures on the economic implications of laboratory testing. The intervention study lasted for 3 years.
Measurements:
Total number of tests performed in each department, number of tests per admission and total cost of each test at Medicare reimbursement prices.
Results:
The number of tests per admission prior to the intervention was 1.91 +/- 0.89; it decreased for each of the next 3 years: 0.76 +/- 0.61, 0.80 +/- 0.62 and 0.78 +/- 0.63 respectively. There was a total decrease of 97,365 tests during the 3-year period, saving 1,914,149 dollars. There was no difference in the readmission rate or in the number of diagnoses of conditions based primarily on blood tests such as hypokalemia or hyponatremia, between department C and the other departments.
Conclusions:
The intervention developed here produced significant and sustained reduction of financial savings in the number of laboratory tests ordered, without negatively impacting diagnostic capability or patient care.
