Evaluation of the Impact of a Pathology Trainee-Driven Manual Review Process for Reference Testing at a Large...

Increasing reliance on and complexity of laboratory testing necessitates laboratory stewardship initiatives to ensure appropriate test ordering, especially as reference testing costs continue to rise. Prospective manual review processes, although demanding of resources, have been shown to be cost-effective, but literature addressing the value of such a process is lacking.

The pathology trainee-driven manual review process of 444 chemistry and microbiology tests on approval at a large academic center was reviewed. Data were extracted from an internal-use call-log and analyzed for test volumes, cancellation rates, and cost savings. A hypergeometric distribution was used to model random variation in cancellation rates to identify outlying high or low cancellation rates. Trainee perspectives were obtained via an anonymous survey.

Of 1597 requests over a 1-year period, 35% were cancelled, saving $108 812, or 23.6%, in direct costs. Our analysis identified outliers with unexpectedly high and low cancellation rates. For example, autoimmune encephalopathy testing on CSF and serum had a low cancellation rate of 20%, while >60% of Hepatitis B e Antibody requests were cancelled. Survey responses from trainees highlighted the educational value of the process but also indicated inefficiencies, highlighting repetitiveness and excessive time spent per request.

This trainee-driven manual review process yields significant cost savings and provides educational benefits, but is labor-intensive and sometimes inefficient. Outlying high and low cancellation rates suggest that alternative stewardship tools and periodic review of cancellation data to enhance process effectiveness may be needed. Future directions include using a similar analysis at timed intervals to identify areas amenable to process improvement.