Structured workflow for send-out test review: operational performance and utilization patterns

Area of Science:

• Laboratory Medicine
• Health Informatics
• Quality Improvement

Background:

• Send-out laboratory testing has grown, increasing complexity and potential inefficiencies.
• Standardizing test review at the request level is challenging despite laboratory stewardship efforts.

Purpose of the Study:

• To implement and evaluate a structured, informatics-enabled workflow for send-out test review.
• To standardize the process of send-out test ordering and review without altering existing clinical criteria.

Main Methods:

• A quality improvement initiative was conducted over 8 months at an academic medical center.
• The informatics-enabled workflow standardized request submission, reviewer notification, decision documentation, and communication.
• A total of 3055 requests were reviewed using the new workflow.

Main Results:

• Documentation completeness reached 98%, with a median review turnaround time of 1 day (83.9% completed within 1 day).
• 81.2% of requests were approved, 11.8% declined/canceled, and 6.9% replaced.
• Review outcomes varied by clinical service, with a few tests dominating declined/modified requests.

Conclusions:

• The structured workflow enabled standardized documentation, rapid turnaround, and better visibility into utilization patterns.
• This informatics approach offers a scalable framework for enhanced laboratory oversight.
• The system supports targeted interventions to optimize test utilization.