What's New in Laboratory Test Utilization Management?

Abstract

The first automobile accident in the US occurred in 1891, only 6 years after Karl Benz developed the first gasoline-powered production automobile. Less poorly documented is the interval of time that elapsed between Yalow's invention of the immunoassay, Mullis' development of the polymerase chain reaction, or Fenn's demonstration of electrospray mass spectrometry and the first orders for clinical laboratory tests based on these technologies that were placed on the wrong patients, for the wrong reasons, at the wrong times. Our lack of documentary evidence of the timeline of laboratory test malutilization notwithstanding, we in the laboratory industry know full well that each step of progress we make towards technical and biomedical innovation in clinical laboratory testing is accompanied by small but significant steps backwards, as medical practitioners misorder the tests we provide owing to confusion, poorly implemented electronic ordering, a culture of medical practice that encourages daily testing, and a panoply of other reasons. The available data converge on an estimate that on average 30% of laboratory tests are ordered inappropriately or are unneeded, and, equally as worrisome, an unknown but sizeable fraction of laboratory tests are underutilized, meaning that they should be ordered but are not. Enter the concept of laboratory test utilization management, or “stewardship,” or “demand management,” or any one of a host of names that describe the role laboratorians can and should play in addressing the problems in our medical systems that conspire to prevent the performance of laboratory tests on the right patients, at the right times, for the right reasons. Although interventions that work (and don't work) to optimize laboratory test utilization have been reported and reviewed extensively in the literature, this Q&A focuses on current topics in the field, with some as-yet unanswered questions posed to leaders in this field. Laboratory test utilization …