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

Area of Science:

• Clinical Chemistry
• Health Economics
• Laboratory Management

Background:

• Healthcare budgets face significant constraints, necessitating strategies to manage increasing laboratory workloads.
• Unnecessary repeat testing accounts for a notable portion (7.4%) of laboratory tests.
• Electronic gatekeeping is an implemented strategy in South Africa to mitigate unnecessary repeat testing.

Purpose of the Study:

• To evaluate the effectiveness of electronic gatekeeping for chemistry tests as a sustainable demand management tool.
• To assess the financial impact and influence on clinician behavior regarding test ordering.

Main Methods:

• A 22-month retrospective study was conducted at a Pretoria hospital, analyzing chemistry test requests.
• Tests violating electronic gatekeeping rules were rejected prior to analysis.
• Cost savings were calculated, and the impact on clinician test requesting patterns was assessed.

Main Results:

• Total savings from rejected tests amounted to $84,380.
• Significant savings were observed for high-cost tests like glycated haemoglobin, urea, and thyroid-stimulating hormone.
• The average percentage of electronic gatekeeping-held tests was 3.18% of total requests over 22 months.

Conclusions:

• While modest savings were achieved, electronic gatekeeping did not substantially alter clinician test requesting patterns.
• The effectiveness of electronic gatekeeping as a standalone demand management strategy appears limited compared to expectations and other studies.
• Further investigation into integrated demand management strategies may be warranted in cost-constrained healthcare settings.