Impact of a computerized intervention to optimize laboratory tests ordering: one-year follow-up in a geriatric unit

Approximately 30 % of laboratory tests are ordered inappropriately, substantially impacting patient care, costs, and carbon footprint of laboratories. Predefined laboratory test panels are a pragmatic and routinely used tool in laboratories, where tests are bundled for efficiency to diagnose or monitor specific conditions. The aim of the present study is to evaluate the impact of optimizing predefined laboratory test panels on the amount of laboratory tests ordered in a geriatric unit.

Geriatricians and laboratory medicine specialists revised existing test-ordering panels to fit current testing guidelines and Belgian reimbursement regulations. The number of tests requested and quality of care outcomes (length of stay, readmission rates, mortality, transfusion events) were monitored and compared for the one-year periods before and after the panel revision. Economic impact was calculated considering costs of manpower, reagents and consumables required for each test. The carbon footprint was estimated using monetary ratios.

Prescription of tests included in ordering panels dropped from 48,502 before the computerized intervention to 38,912 afterward (a 30 %-fold change normalized by blood sampling per period), with no adverse impact on quality of care. Those 9,590 spared laboratory tests correspond to a saving of €7,974 and a reduction of 2,042 kg CO₂ equivalent emissions for the laboratory. Regarding tests excluded from the computerized ordering panels, reductions ranged from 30 % for white blood cell differential to 78 % for activated partial thromboplastin time tests.

Reshaping predefined laboratory test panels in collaboration with geriatricians represents an effective strategy to tackle test overprescription in laboratory medicine in a geriatric unit.