Efficiency of test report delivery to the requesting physician in an outpatient setting: an observational study

Clinical laboratories accredited according to ISO 15189 quality standards are obliged to implement and continuously monitor quality indicators for evaluation of the laboratory's contribution to patient care. Reporting laboratory results to the requesting physician is one important phase of the clinical laboratory testing process. Failure to report results may indicate the ineffectiveness of the laboratory service. We aimed to analyze the proportion and type of laboratory reports for outpatients that were not delivered to the requesting physician.

This retrospective observational study was conducted during an 11-month period from January to December 2007 at our outpatient biochemistry laboratory unit. Data on demographic characteristics, request types and laboratory findings for all uncollected reports were retrieved from the laboratory information system and compared with one random 2-week representative period.

During the study period our laboratory issued 22,445 patient reports with more than 150,000 biochemistry analyses. Of these, 464 (2.1%) were uncollected laboratory reports. When compared to the representative period, patients who never collected their laboratory reports were younger (p<0.001) or suffering from some chronic disease. Routine biochemistry tests were the most prevalent (>50%). The majority of routine biochemistry tests were almost equally represented during the study and representative period, while molecular diagnostic tests were several times more frequently uncollected (p<0.001). Reports with electrolytes, metabolites and glucose were the least likely to be uncollected (p<0.001). The total cost for those tests was 30% of the average monthly laboratory budget.

A significant amount of the laboratory budget is wasted for tests that never reach the requesting physician. Such misutilization of the laboratory reveals the substantial lack of medical necessity for test requests. Further studies are needed to explore the possible efficiency of the various interventions in reducing the volume of unnecessary and erroneous testing.