Implementing minimal request intervals for laboratory tests: a utilization management study across eight hospitals in...

Effective utilization management in medical laboratories is a challenge. To address this, strategies such as clinical guidelines, minimum requesting intervals (MRIs), and test request limits integrated into hospital information system (HIS) have been proposed.

A guideline was developed to establish MRIs for 15 high-demand laboratory tests in collaboration with an expert panel. It was implemented across eight public hospitals, affiliated with Shiraz University of Medical Sciences, Shiraz, southern Iran. Following institutional approval, the HIS was programmed to notify healthcare providers of deviations from guideline. Several metrics, including requested test counts, hospitalized patient counts, and total hospitalization days, were extracted from the HIS for one year pre- and post-intervention. Then, rates of change in test utilization and associated financial savings were calculated.

A total of 414,475 unnecessary tests were averted during the first post-intervention year. In addition, a 12.26% decrease was observed in the test-to-hospitalization-day ratio. The highest decreases obtained for serum calcium (25.87%), serum albumin (22.17%), and alanine aminotransferase (21.03%) testing.

Implementing MRI guidelines into the HIS to flag deviations is an effective strategy for laboratory utilization management. Its benefits are multi-faceted, including financial savings (decreased patient and insurer costs), clinical advantages (minimizing diagnostic ambiguity and patient mismanagement), and optimized laboratory resource allocation (staff workload, instrument usage, reagent efficiency).