Laboratory test utilization before and after intervention in a secondary care Finnish geriatric inpatient hospital

Abstract

Abstract Background Laboratory testing influences up to 60–70% of treatment decisions, yet overuse, underuse and misuse of diagnostic tests is common. The aim of this study was to improve the quality of laboratory testing in a secondary care hospital. Methods The study design was a prospective before and after setting. The data regarding ordered laboratory tests, sample collections, and laboratory penalty charges during 2013–2015 was collected and evaluated. Areas of improvement were identified and an intervention was designed including updating the electronic form for ordering laboratory tests, and organizing educational sessions for doctors followed by monthly short reminders of the topic. Laboratory utilization before and after the intervention was compared using logistic regression analysis. The effect of the intervention was followed up throughout 2016–2018. Results Laboratory testing before the intervention was unchanged in 2013–2015. The five most common analyses: complete blood count (CBC), C-reactive protein (CRP), blood creatinine (SCR), blood sodium and potassium, constituted 67.5% of all laboratory tests. Utilization of most common tests per patient (CBC, CRP, SCR, sodium, potassium, INR) was reduced statistically significantly after the intervention. The number on overall tests per bed day and per patient were discovered statistically significantly lower after the intervention along with sample collection. Most of the identified problems (the overuse of AST and FOBT, the underutilization of B12TC2) were corrected. Inappropriate test utilization, mix-up of tests, and use of outdated tests were identified and found to be unnecessarily costly. Laboratory test ordering decreased by 9.6% and sample collection by 7.2% in the year following the intervention due to the decrease in the number of the most ordered tests. No improvement was seen for laboratory tests usually ordered by nurses, as they were not included in the intervention. Conclusions Reduction of unnecessary laboratory testing was achieved by an intervention including two parts: education and changing the electronic ordering form. Continuous education of doctors was found to be an effective tool for efficient use of laboratory tests. Future interventions should include nurses.