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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Reducing Test Utilization in Hospital Settings: A Narrative Review.

Renuka S Bindraban1,2, Maarten J Ten Berg1, Christiana A Naaktgeboren1,3

  • 1Departments of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands.

Annals of Laboratory Medicine
|May 26, 2018
PubMed
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Interventions can reduce unnecessary laboratory testing, but long-term effectiveness and optimal strategies remain unclear. More controlled trials are needed to assess sustainability and clinical impact.

Keywords:
InterventionLaboratory testingLaboratory utilizationReductionUnnecessary laboratory testingUnnecessary laboratory utilization

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Area of Science:

  • Health Services Research
  • Clinical Pathology
  • Healthcare Management

Background:

  • Laboratory test overutilization is estimated at 20% in hospital settings.
  • Appropriateness of laboratory testing is a significant concern in healthcare.
  • There is a need to identify effective strategies for reducing unnecessary laboratory tests.

Purpose of the Study:

  • To review interventions reducing unnecessary laboratory testing in hospitals.
  • To estimate the efficacy of these interventions on test order volume and clinical outcomes.

Main Methods:

  • A narrative review of studies from major databases (PubMed, Embase, Scopus, Web of Science, CADTH HTA).
  • Data extraction on test order volume and clinical outcomes by a single reviewer, with consensus for uncertainties.
  • No meta-analysis due to heterogeneity of interventions and outcomes.

Main Results:

  • Eighty-four studies were included, categorizing interventions into educational, (computerized) provider order entry [(C)POE], audit/feedback, or other.
  • Nearly all studies reported reduced test order volume.
  • Only 15 studies assessed sustainability up to two years; 45 reported clinical outcomes, with two showing negative effects.

Conclusions:

  • All intervention categories show potential for reducing unnecessary laboratory tests, but long-term sustainability is uncertain.
  • Heterogeneity in interventions and outcomes prevents definitive conclusions on the most successful approach.
  • Methodological limitations, including lack of control arms, highlight the need for well-designed trials with clear outcomes.