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The laboratory test justified. An effective means to reduce routine laboratory testing
American Journal of Clinical Pathology
|December 1, 1985
Summary
Implementing a clinician justification policy significantly reduced common clinical laboratory tests. This strategy lowered test volumes by requiring written rationales for ordering, particularly effective for frequently used tests.
Area of Science:
- Clinical Pathology
- Health Services Research
Background:
- Clinical laboratory testing volume is a significant healthcare cost.
- Strategies to control test ordering are crucial for efficiency.
Purpose of the Study:
- To evaluate the effectiveness of a clinician-oriented restriction policy on laboratory test ordering.
- To assess the impact of a written justification requirement on reducing test volumes.
Main Methods:
- Implemented a policy requiring written justification for laboratory test requests.
- Applied directed justification for specific tests (prothrombin time, partial thromboplastin time) and nonspecific justification for leukocyte differentials.
- Extended the policy to general medical wards, focusing on common laboratory tests (BUN/creatinine, electrolytes).
Main Results:
- Directed justification reduced prothrombin time and partial thromboplastin time by 44% (P < 0.001).
- Nonspecific justification reduced leukocyte differentials by 35% (P < 0.001).
- The broader policy reduced common tests (BUN/creatinine, electrolytes) by 28-45% without reviewing justification validity.
Conclusions:
- A simple clerical justification policy can significantly reduce the volume of common clinical laboratory tests.
- This approach allows clinicians to retain responsibility for test ordering while decreasing laboratory workload.
- The policy appears most effective for frequently ordered tests.
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