Abstract
BackgroundIn recent years inappropriate and excessive use of clinical laboratory facilities has become a cause of concern and has led to concurrent rise in the laboratory errors and the health care costs. The aim of the study was to find out the frequency of incomplete laboratory request forms, inappropriate test requests at various professional levels and the financial impact of uncollected reports at Armed Forces Institute of Pathology (AFIP) and Combined Military Hospital (CMH) Laboratory Rawalpindi.MethodsThe cross-sectional descriptive study was conducted during a three month period from April to June 2012 at AFIP and CMH Laboratory Rawalpindi. A total of 1000 laboratory request forms were collected and scrutinized for completion from AFIP (n=500) and CMH Rawalpindi laboratory (n=500). 536 request forms of costly/specialized tests from different departments of AFIP were studied to find out the professional level of test request. The total number of tests performed at AFIP during the study period and number of uncollected reports were noted. The financial impact of these uncollected reports was also calculated. Collection of data and sorting were done manually. Patient confidentiality was maintained. Microsoft excel software and SPSS-17 were used for analysis. The study was approved by the Institutional Ethical Review Committee.ResultsOut of a total of 1000 forms studied none was completely filled with clinical notes being present in only 2.4% and 13% of forms sent to CMH and AFIP respectively. 62% of the expensive investigations were requested by specialists while 38% were ordered by residents and general practitioners but the percentage of avoidable expensive tests ordered by the general practitioners and residents was significantly higher than the specialists(p<0.001). A total of 9026 (40%) and 5046 (22%) diagnostic test reports were not collected from the Chemical pathology and Hematology departments respectively. Financial impact of uncollected reports from all the departments at AFIP collectively amounted to Pakistani Rupees (PKR) 3338201.ConclusionProcessing incomplete laboratory request forms and injudicious use of laboratory facilities leads to incorrect interpretation of laboratory test results affecting outcome of the overall treatment.
Highlights
In recent years inappropriate and excessive use of clinical laboratory facilities has become a cause of concern and has led to concurrent rise in the laboratory errors and the health care costs
We interviewed the physicians and pathologists at Combined Military Hospital (CMH) Rawalpindi, MH Rawalpindi and Armed Forces Institute of Pathology (AFIP) to get their point of view regarding incomplete laboratory request forms, inappropriate test requests at various professional levels and uncollected reports all the above mentioned issues
Though name was written on 100% forms, diagnosis was written on 9% and 22% forms while clinical notes were written on 2.4% and 12.6% for CMH Laboratory and AFIP respectively
Summary
In recent years inappropriate and excessive use of clinical laboratory facilities has become a cause of concern and has led to concurrent rise in the laboratory errors and the health care costs. In recent years inappropriate and excessive use of clinical laboratory facilities has become a cause of concern. Study states that pre-analytical errors in completing request forms may lead to incorrect interpretation and poor patient diagnosis and treatment [5]. Another major factor is lack of adequate training in ordering laboratory tests by the physicians and their use for non-targeted and vague therapeutic purposes [6]
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