title: Demand management: an audit of chemical pathology test rejections by an electronic gate-keeping system at an academic hospital in Cape Town.
abstract: BACKGROUND
  Demand management is an area of laboratory activity, which is becoming increasingly important. Within the health-care system, demand management can be defined as the use of health resources to maximise its utility. Tygerberg Hospital has introduced an electronic gate-keeping system. Chemistry tests which generate the highest cost are subjected to this system and may be automatically rejected according to a set of rules. This study aimed: (1) to identify the number of chemistry tests rejected by the eGK; (2) to identify which of these rejected tests were subsequently restored and (3) to assess the impact of rejections on clinical outcome and cost-saving.
  
  
  METHODS
  A retrospective audit was conducted to determine the number of chemistry tests rejected and subsequently restored over a 6-month period. The case-notes of patients for whom requested tests previously rejected had been restored were randomly selected and investigated to assess clinical impact. Any cost-saving was calculated.
  
  
  RESULTS
  A total of 68,480 tests were subjected to gate-keeping, and 4605 tests (6.7%) were rejected while 679 (14.7%) of these were restored by the requestor phoning the laboratory after obtaining authorisation. After examining a subset of clinical notes it was found that in most cases (80%), patient care was unaffected. The total cost saved was £ 25,387.
  
  
  CONCLUSIONS
  The majority of the rejected tests were unnecessary and following rejection, real savings were made. Electronic gate-keeping is a simple, effective and sustainable method of demand management.
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa.
authors.forename: Ida
authors.initials: I
authors.lastname: Smit
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa azemlin@sun.ac.za.
authors.forename: Annalise E
authors.initials: AE
authors.lastname: Zemlin
authors.affiliation: Division of Chemical Pathology, Faculty of Health Sciences, National Health Laboratory Service (NHLS) and Stellenbosch University, Cape Town, South Africa.
authors.forename: Rajiv T
authors.initials: RT
authors.lastname: Erasmus
mesh_terms: D019963:Clinical Chemistry Tests / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D019468:Disease Management; D006301:Health Services Needs and Demand / Q000458:organization & administration* / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D008485:Medical Audit; D010337:Pathology Department, Hospital / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013019:South Africa
keywords: Demand management; audit; cost-saving; electronic gate-keeping