Managing inappropriate utilization of laboratory resources

doi:10.1515/dx-2018-0029

Review

. 2019 Mar 26;6(1):5-13.

doi: 10.1515/dx-2018-0029.

Managing inappropriate utilization of laboratory resources

Janne Cadamuro¹, Mercedes Ibarz², Michael Cornes³, Mads Nybo⁴, Elisabeth Haschke-Becher⁵, Alexander von Meyer⁶, Giuseppe Lippi⁷, Ana-Maria Simundic⁸

Affiliations

¹ Department of Laboratory Medicine, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria, Phone: +43-57255-57263, Fax: +43-57255-23199.
² Laboratory Medicine Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain.
³ Clinical Chemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK.
⁴ Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
⁵ Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.
⁶ Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany.
⁷ Section of Clinical Biochemistry, University of Verona, Verona, Italy.
⁸ Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.

PMID: 30096052
DOI: 10.1515/dx-2018-0029

Free article

Review

Managing inappropriate utilization of laboratory resources

Janne Cadamuro et al. Diagnosis (Berl). 2019.

Free article

. 2019 Mar 26;6(1):5-13.

doi: 10.1515/dx-2018-0029.

Authors

Janne Cadamuro¹, Mercedes Ibarz², Michael Cornes³, Mads Nybo⁴, Elisabeth Haschke-Becher⁵, Alexander von Meyer⁶, Giuseppe Lippi⁷, Ana-Maria Simundic⁸

Affiliations

¹ Department of Laboratory Medicine, Paracelsus Medical University, Müllner Hauptstr. 48, 5020 Salzburg, Austria, Phone: +43-57255-57263, Fax: +43-57255-23199.
² Laboratory Medicine Department, University Hospital Arnau de Vilanova, IRBLleida, Lleida, Spain.
³ Clinical Chemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK.
⁴ Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
⁵ Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.
⁶ Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany.
⁷ Section of Clinical Biochemistry, University of Verona, Verona, Italy.
⁸ Department of Medical Laboratory Diagnostics, University Hospital "Sveti Duh", Zagreb, Croatia.

PMID: 30096052
DOI: 10.1515/dx-2018-0029

Abstract

Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources.

Keywords: inappropriateness of laboratory utilization; overutilization; postanalytics; preanalytics; test demand management.

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References

1. Lippi G, Plebani M. The add value of laboratory diagnostics: the many reasons why decision-makers should actually care. J Lab Prec Med 2017;2:1–4.
1. Orth M, Averina M, Chatzipanagiotou S, Faure G, Haushofer A, Kusec V, et al. Opinion: redefining the role of the physician in laboratory medicine in the context of emerging technologies, personalised medicine and patient autonomy (‘4P medicine’). J Clin Pathol 2017:1–7. doi: 10.1136/jjclinpath-2017–204734.
1. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267–315.
1. American Diabetes Association. Standards of Medical Care in Diabetes – 2015. Diabetes Care 2015;38(Suppl 1):S1–S93.
1. de Koning TJ, Jongbloed JD, Sikkema-Raddatz B, Sinke RJ. Targeted next-generation sequencing panels for monogenetic disorders in clinical diagnostics: the opportunities and challenges. Expert Rev Mol Diagn 2015;15:61–70.

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[1] Lippi G, Plebani M. The add value of laboratory diagnostics: the many reasons why decision-makers should actually care. J Lab Prec Med 2017;2:1–4.

[2] Lippi G, Plebani M. The add value of laboratory diagnostics: the many reasons why decision-makers should actually care. J Lab Prec Med 2017;2:1–4.

[3] Orth M, Averina M, Chatzipanagiotou S, Faure G, Haushofer A, Kusec V, et al. Opinion: redefining the role of the physician in laboratory medicine in the context of emerging technologies, personalised medicine and patient autonomy (‘4P medicine’). J Clin Pathol 2017:1–7. doi: 10.1136/jjclinpath-2017–204734.

[4] Orth M, Averina M, Chatzipanagiotou S, Faure G, Haushofer A, Kusec V, et al. Opinion: redefining the role of the physician in laboratory medicine in the context of emerging technologies, personalised medicine and patient autonomy (‘4P medicine’). J Clin Pathol 2017:1–7. doi: 10.1136/jjclinpath-2017–204734.

[5] Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267–315.

[6] Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37:267–315.

[7] American Diabetes Association. Standards of Medical Care in Diabetes – 2015. Diabetes Care 2015;38(Suppl 1):S1–S93.

[8] American Diabetes Association. Standards of Medical Care in Diabetes – 2015. Diabetes Care 2015;38(Suppl 1):S1–S93.

[9] de Koning TJ, Jongbloed JD, Sikkema-Raddatz B, Sinke RJ. Targeted next-generation sequencing panels for monogenetic disorders in clinical diagnostics: the opportunities and challenges. Expert Rev Mol Diagn 2015;15:61–70.

[10] de Koning TJ, Jongbloed JD, Sikkema-Raddatz B, Sinke RJ. Targeted next-generation sequencing panels for monogenetic disorders in clinical diagnostics: the opportunities and challenges. Expert Rev Mol Diagn 2015;15:61–70.

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Managing inappropriate utilization of laboratory resources

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Managing inappropriate utilization of laboratory resources

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