Ann Lab Med.  2018 Sep;38(5):402-412. 10.3343/alm.2018.38.5.402.

Reducing Test Utilization in Hospital Settings: A Narrative Review

• Bindraban
• ten Berg M
• Naaktgeboren CA
• Kramer MH
• van Solinge WW
• Nanayakkara PWB

• KMID: 2434728
• DOI: http://doi.org/10.3343/alm.2018.38.5.402

Abstract

BACKGROUND
Studies addressing the appropriateness of laboratory testing have revealed approximately 20% overutilization. We conducted a narrative review to (1) describe current interventions aimed at reducing unnecessary laboratory testing, specifically in hospital settings, and (2) provide estimates of their efficacy in reducing test order volume and improving patient-related clinical outcomes.
METHODS
The PubMed, Embase, Scopus, Web of Science, and Canadian Agency for Drugs and Technologies in Health-Health Technology Assessment databases were searched for studies describing the effects of interventions aimed at reducing unnecessary laboratory tests. Data on test order volume and clinical outcomes were extracted by one reviewer, while uncertainties were discussed with two other reviewers. Because of the heterogeneity of interventions and outcomes, no meta-analysis was performed.
RESULTS
Eighty-four studies were included. Interventions were categorized into educational, (computerized) provider order entry [(C)POE], audit and feedback, or other interventions. Nearly all studies reported a reduction in test order volume. Only 15 assessed sustainability up to two years. Patient-related clinical outcomes were reported in 45 studies, two of which found negative effects.
CONCLUSIONS
Interventions from all categories have the potential to reduce unnecessary laboratory testing, although long-term sustainability is questionable. Owing to the heterogeneity of the interventions studied, it is difficult to conclude which approach was most successful, and for which tests. Most studies had methodological limitations, such as the absence of a control arm. Therefore, well-designed, controlled trials using clearly described interventions and relevant clinical outcomes are needed.

Keyword

Laboratory utilization; Laboratory testing; Unnecessary laboratory utilization; Unnecessary laboratory testing; Reduction; Intervention

MeSH Terms

Arm
Cost Savings
Hospitals
Laboratories

Figure

• 

  Fig. 1 Flowchart of the literature search algorithm used for identifying and selecting studies for inclusion in this review.Abbrevations: CADTH HTA, Canadian Agency for Drugs and Technologies in Health-Health Technology Assessment.

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