Assessing cost savings when unnecessary utilization of laboratory tests can be abolished

The authors report on the theoretic cost savings that would be realized if presumed overutilization of selected laboratory tests could be eliminated. They limit the scope of this study to inpatients at the University Hospital and on a preselected subset of assays ordered in their institution. A baseline audit including the requests for 19 commonly ordered clinical chemistry tests made for all inpatients during three weekdays was performed at our 400-bed hospital. Eight of the 19 tests (the LYTES-Plus), were done on the ASTRA-8 selective multitest analyzer (Beckman Instruments Inc., Brea, CA 92621), while remaining 11 tests (MTA-11) were performed on the RA-1000 selective multitest system (Technicon Instruments Corp., Tarrytown, NY 10591). The average tests ordered per patient-day were 4.38 of the 19, and the average venipunctures were 0.67. The corresponding numbers for the intensive care patients were 16.6 tests and 2.45 venipunctures per patient-day. Although the intensive care units contributed approximately 8% of the patient days in the hospital, they represented more than 25% of the tests ordered. The authors noted that 5.89 of the eight possible LYTES-Plus assays were ordered per ASTRA-8 sample. The equivalent figure for MTA-11 was 4.55 of 11 possible tests. Using list prices of reagents and disposables, the savings in direct material costs resulting from implementing a number of rather conservative recommendations for decreasing overutilization was estimated to be $45,000 per annum or 31% of the total direct material costs.