Managing inappropriate requests of laboratory tests: from detection to monitoring.
OBJECTIVE
The main objectives of this study were to show a simple approach to detect inappropriate requests of laboratory tests and to monitor success after establishing interventions. These objectives were monitored through process and outcome indicators customized according to the type and phase of the appropriateness strategy.


METHODS
Quasi-experimental design.


METHODS
Based on evidence regarding laboratory test utilization differences among different geographical areas of Spain, we identified serum calcium (s-Ca) testing to be underrequested and total bilirubin (tBil) testing to be overrequested in primary care patients who undergo testing at the Public University Hospital of San Juan, in San Juan de Alicante, Alicante, Spain. Additionally, the ratio of free thyroxine (FT4) tests to thyrotropin (also called thyroid-stimulating hormone [TSH]) tests was well above the published 0.25 goal in primary care. Finally, numerous laboratory tests were overrequested in hospitalized patients due to repetitive testing. We designed and implemented a variety of strategies to correct such inappropriateness and designed different indicators to monitor the intervention success over time.


RESULTS
After implementation of the different strategies, the absolute number of s-Ca tests increased. The number of tBil tests in primary care, and numerous other tests repeated too frequently in hospitalized patients, decreased. The FT4/TSH indicator goal was reached and maintained over time. Regarding the outcome indicators, the strategy of reducing tBil tests in primary care and reducing the aggregate of unnecessary tests in hospitalized patients resulted in savings of $3543.80 and $9825.50, respectively, from January 2012 to December 2014. The s-Ca strategy, from November 2011 to December 2014, detected 62 subjects' primary hyperparathyroidism at a cost of $137.80 per case.


CONCLUSIONS
The study demonstrates a simple approach to detect inappropriate requests of laboratory tests, and how to assess the potential success of interventions using process and outcome indicators.
Hospital Universitario de San Juan, Carretera Nacional 322, s/n 03550, San Juan de Alicante, Alicante, Spain. E-mail: salinas_mar@gva.es.
Maria
M
Salinas
Maite
M
López-Garrigós
Emilio
E
Flores
Maria
M
Leiva-Salinas
Alberto
A
Asencio
Javier
J
Lugo
Carlos
C
Leiva-Salinas
D019411:Clinical Laboratory Techniques / Q000191:economics* / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization; D006779:Hospitals, Public; D006785:Hospitals, University; D006801:Humans; D011320:Primary Health Care; D013030:Spain