Appropriate utilization and cost control of the hospital laboratory: panel testing and repeat orders

Analysis of hospital laboratory utilization shows a bi-exponential relationship between the many different test combinations ordered and their frequency of use. This suggests two opposite strategies to reduce test volume. Policy could discourage use of the most popular request combinations to reduce volume, or policy could discourage use of the least popular request combinations to reduce order variety. Analysis of biochemical test orders further suggests that the largest part of test requests is associated with a small number of pathophysiological issues, namely those involving electrolytes, fluid balance, blood lipids, heart, liver, kidney or bone disease. Therefore, efficiency results when a limited number of standard test panels addressing these issues reduce order variety by discouraging infrequently used test combinations. Standard panels can be developed from an analysis of the most popular existing orders, accepting some degree of discrepancy among otherwise overlapping requests. This empiric approach avoids sterile debate about the composition of ideal panels. Since the resources of the laboratory, the mix of patients served and local medical tradition affect test orders, each institution providing health care must develop the standard panels best suited to its needs. Analysis of standing repeat orders suggests they are often used to anticipate potential pathology in stable patients. Therefore, economy results when test volume is reduced by discouraging series of futile repeat tests with unchanging normal results. Unfortunately, an empiric approach to regulate repeat orders is not available and only a more cumbersome process to build a locally agreed upon consensus between providers and users of laboratory services offers itself as a promising solution.