title: An effective utilization management strategy by dual approach of influencing physician ordering and gate keeping.
abstract: OBJECTIVE
  There is increasing recognition of the importance of appropriate laboratory test utilization. We investigate the effect of a multifaceted educational approach that includes physician feedback on individual test ordering, in conjunction with targeted restriction, on the utilization of selected laboratory tests.
  
  
  METHODS
  Scientific evidence was compiled on the usefulness and limitations of tests suspected of being over utilized in our laboratories. A variety of approaches were used to deliver education on each of the targeted tests, with greater focus on primary care physicians (PCPs). Feedback on requesting behavior of these tests was also communicated to the latter group which included an educational component. Laboratory based restriction of testing was also exercised, including the unbundling of our electrolyte panel.
  
  
  RESULTS
  PCP requesting patterns for the selected tests were found to be markedly skewed. The interventions implemented over the study period resulted in a substantial 51% reduction in overall ordering of five of the targeted tests equating to an annual marginal cost saving of $60,124. Unbundling of the electrolyte panel resulted in marginal cost savings that equated annually to $42,500 on chloride and $48,000 on total CO2.
  
  
  CONCLUSIONS
  A multifaceted educational approach combined with feedback on utilization and laboratory driven gate-keeping significantly reduced the number of laboratory tests suspected of being redundant or unjustifiably requested. Laboratory professionals are well positioned to manage demand on laboratory tests by utilizing evidence base in developing specific test ordering directives and gate-keeping rules.
authors.affiliation: Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: manal.elnenaei@nshealth.ca.
authors.forename: Manal O
authors.initials: MO
authors.lastname: Elnenaei
authors.affiliation: Department of Emergency Medicine, Dalhousie University and Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada. Electronic address: samuel.campbell@nshealth.ca.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Campbell
authors.affiliation: Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: andrea.thoni@nshealth.ca.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Thoni
authors.affiliation: Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: amy.lou@nshealth.ca.
authors.forename: Amy
authors.initials: A
authors.lastname: Lou
authors.affiliation: Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: bryan.crocker@nshealth.ca.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Crocker
authors.affiliation: Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: bassam.nassar@nshealth.ca.
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Nassar
mesh_terms: D019411:Clinical Laboratory Techniques / Q000191:economics / Q000706:statistics & numerical data*; D019468:Disease Management; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000592:standards*; D019564:Unnecessary Procedures / Q000191:economics
keywords: Demand management; Evidence based laboratory medicine; Test utilization