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How do experts determine where to intervene on test ordering? An interview study.

Eyal Podolsky1, Natasha Hudek1, Nicola McCleary2

  • 1Centre for Practice Changing Research, Ottawa Hospital Research Institute, Methodological and Implementation Research (MIR) Program, The Ottawa Hospital, General Campus, Ottawa, ON, Canada.

Clinical Chemistry and Laboratory Medicine
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Experts identified key factors like test volume, value, and patient care for laboratory stewardship interventions. Developing a framework requires collaboration and consideration of local context for effective resource allocation in healthcare.

Keywords:
laboratory testinglow-value caresemi-structured interview

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Area of Science:

  • Healthcare Management
  • Clinical Laboratory Science
  • Health Services Research

Background:

  • Laboratory testing is a high-volume service prone to overuse, leading to resource waste and suboptimal patient care.
  • Optimizing laboratory test ordering in tertiary care requires strategic resource allocation, but guidance is lacking.

Purpose of the Study:

  • To explore context-specific factors and decision-making processes for laboratory stewardship interventions.
  • To identify key considerations for prioritizing laboratory tests for intervention.

Main Methods:

  • Semi-structured interviews were conducted with 14 experts in test-ordering intervention development and guidance authorship.
  • Data analysis involved directed-content and thematic analysis of interview transcripts.

Main Results:

  • Experts prioritize tests based on volume, value, and patient care, though quantifying these factors is challenging.
  • Decision-making processes include local data review, stakeholder buy-in, and adherence to existing guidelines.
  • Framework development suggestions emphasize collaboration, context, resource awareness, and incremental implementation ('easy wins').

Conclusions:

  • The study offers insights into expert decision-making for selecting laboratory tests for intervention.
  • Findings can inform the development of a framework to guide test selection and guideline creation for laboratory stewardship.