A cost-effective interdisciplinary approach to microbiologic send-out test use.
BACKGROUND
Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine.


OBJECTIVE
To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing.


METHODS
The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation.


RESULTS
Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication.


CONCLUSIONS
Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.
From the Department of Pathology (Drs Aesif and Keiser), and the Divisions of Infectious Diseases (Dr Parenti) and Hospital Medicine (Dr Lesky), Department of Medicine, The George Washington University, Washington, DC.
Scott W
SW
Aesif
David M
DM
Parenti
Linda
L
Lesky
John F
JF
Keiser
D064790:Clinical Laboratory Services / Q000191:economics; D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D008828:Microbiological Techniques / Q000191:economics* / Q000592:standards / Q000706:statistics & numerical data; D020416:Outsourced Services / Q000191:economics* / Q000706:statistics & numerical data; D010337:Pathology Department, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D010820:Physicians; D012017:Referral and Consultation; D014481:United States; D014600:Utilization Review