A cost-effective interdisciplinary approach to microbiologic send-out test use

Area of Science:

• Clinical Pathology
• Medical Laboratory Science
• Health Economics

Background:

• Reference laboratory testing (send-out tests) incurs substantial costs in clinical laboratories.
• Increasing use of complex molecular diagnostics necessitates cost-reduction strategies for high-value healthcare.

Purpose of the Study:

• To implement and evaluate a strategy for optimizing microbiologic send-out test utilization.
• To involve clinical pathology house staff and hospital clinicians in cost-effective test management.

Main Methods:

• A 370-bed academic hospital screened all microbiologic send-out test requisitions in 2012.
• Clinical pathology house staff reviewed tests for utility, consulting with ordering clinicians on questionable requests.
• Interdisciplinary rounds and direct consultations were used to address test indications.

Main Results:

• A 38% cancellation rate of send-out tests was achieved through screening, leading to cost savings.
• Nucleic acid tests were frequently screened and represented the largest proportion of cost savings.
• Lack of clinical indication was the primary reason for test cancellation after consultation.

Conclusions:

• Direct, face-to-face consultation between pathology staff and clinicians is effective.
• This interdisciplinary approach successfully manages send-out testing in microbiology.
• The strategy supports cost-effective medicine through optimized laboratory test utilization.