Abstract
The overuse of clinical laboratory services has been documented for many years. This overuse use does not contribute to the quality of medical care, does not shorten hospital stay, nor reduce mortality. The utilization of diagnostic laboratories has increased over the last decade around the world. This increased laboratory use is appropriate if it allows accurate diagnoses to be made, ideal treatment to be identified and monitored, accurate prognoses to be established, and patients’ hospital stays to be shortened. Thus, improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement program. In this study, the effectiveness of a computer-based system in improving the laboratory test-ordering in a general hospital was investigated. The study was conducted through four stages, the preparation stage, the pre-intervention stage, the post-intervention 1) stage and post-intervention 2) stage. Guideline and computer system were developed during preparation stage. Medical records were reviewed against guideline recommendations before any intervention during the pre-intervention stage, after guideline dissemination through educational workshops during the post intervention 1) stage, and after implementation of the computer system with the new requesting form during the post intervention 2) stage. The study revealed that the computer-based system achieved a statistically significant increase in the percentage of appropriate use from 44.6% in the post-intervention 1) stage to 55.6%, and a statistically significant increase in the compliance with guideline by prescriber as well as increased in guideline conformity rate from 16.7% in the post-intervention 1) stage to 32.5% in the post-intervention 2) stage, and decreased in the percentage of prescribers whose level was unsatisfactory from 85.4% the post-intervention 1) stage to 66.7% in the post-intervention 2) stage.
Highlights
Appropriate laboratory services utilization is a cornerstone of optimal medical practice
The effectiveness of a computer-based system in improving the laboratory test-ordering in a general hospital was investigated
Medical records were reviewed against guideline recommendations before any intervention during the pre-intervention stage, after guideline dissemination through educational workshops during the post intervention 1) stage, and after implementation of the computer system with the new requesting form during the post intervention 2) stage
Summary
Appropriate laboratory services utilization is a cornerstone of optimal medical practice. Laboratory services utilization is appropriate if it allows accurate diagnoses to be made, ideal treatment to be identified and monitored, accurate prognoses to be established, and patients’ hospital stays to be shortened [1,2]. Appropriate laboratory utilization—as an ongoing process of making the best use of laboratory resources— could be defined as ordering the right tests and interpreting them properly to complete the diagnosis and evaluation of the patient disease [3,4]. The appropriateness of laboratory utilization could be assessed based on implicit as opposed to explicit criteria. The implicit review is based on subjective criteria and relies on interpretation by the reviewer. All audit criteria require the chart reviewer to identify each patient’s symptoms or diagnoses to determine test appropriateness [6,7]
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