The Frequency and Cost of Redundant Biochemistry Test in Tertiary Teaching Hospital
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Abstract
Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST, Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600 thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration among physicians and laboratory professionals can minimise test inappropriateness.
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Rohr UP, Binder C, Dieterle T, Giusti F, Messina CG, Toerien E, et al. The value of in vitro diagnostic testing in medical practice: a status report. PloS one 2016;11:e0149856.
Lippi G, Bovo C, Ciaccio M. Inappropriateness in laboratory medicine: an elephant in the room?. Ann Transl Med 2017; 5:82
Hickner J, Thompson PJ, Wilkinson T, Epner P, Shaheen M, Pollock AM, et al. Primary care physicians’ challenges in ordering clinical laboratory tests and interpreting results. J Am Board Fam Med 2014; 27:268-74.
Freedman DB. Towards better test utilisation–strategies to improve physician ordering and their impact on patient outcomes. EJIFCC 2015; 26:15.
Domenighetti G, Vernero S. Looking for waste and inappropriateness: if not now, when. Intern Emerg Med 2014; 9:1-7.
Meidani Z, Mousavi GA, Kheirkhah D, Benar N, Maleki MR, Sharifi M, et al. Going beyond audit and feedback: towards behaviour-based interventions to change physician laboratory test ordering behaviour. J R Coll Physicians Edinb 2017; 47:339-344.
Wertheim BM, Aguirre AJ, Bhattacharyya RP, Chorba J, Jadhav AP, Kerry VB, et al. An educational and administrative intervention to promote rational laboratory test ordering on an academic general medicine service. Am J Med 2017; 130:47-53.
Elnenaei MO, Campbell SG, Thoni AJ, Lou A, Crocker BD, Nassar BA. An effective utilisation management strategy by dual approach of influencing physician ordering and gate keeping. Clin Biochem 2016; 49:208-212.
Cuda G, Guzzi PH, Gallo L, Lentini M, Lucia F, Giacinto-Carinci L, et al. Evaluating the inappropriateness of repeated laboratory testing in a teaching hospital of South Italy. Clin Chem Lab Med 2014; 52:e43-44.
Oliveira AM, Oliveira MV, Souza CL. Prevalence of unnecessary laboratory tests and related avoidable costs in intensive care unit. Jornal Brasileiro de Patologia e Medicina Laboratorial 2014;50:410-416.
Lapić I, Rogić D, Fuček M, Galović R. Effectiveness of minimum re-testing intervals in managing repetitive laboratory testing: experience from a Croatian university hospital. Biochem Med (Zagreb) 2019; 29:531-558.
Cadamuro J, Gaksch M, Wiedemann H, Lippi G, von Meyer A, Pertersmann A, et al. Are laboratory tests always needed? Frequency and causes of laboratory overuse in a hospital setting. Clin Biochem 2018; 54:85-91.
Ortashi O, Virdee J, Hassan R, Mutrynowski T, Abu-Zidan F. The practice of defensive medicine among hospital doctors in the United Kingdom. BMC Med Ethics 2013;14(1):42.
Lau NK, LAU KN, MAK CM. Survey on Chemical Pathology Teaching in Medical Curricula: Insight into Patient Safety. Biomed J 2018; 2:9.
Kılınçarslan MG, Şahin EM, Korkmazer B. Prevalence and associated factors of inappropriate repeat test. Postgrad Medical J 2019; 95:596-600.
Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PloS one 2013; 8:e78962.
Kandalam V, Lau CK, Guo M, Ma I, Naugler C. Inappropriate repeat testing of complete blood count (CBC) and electrolyte panels in inpatients from Alberta, Canada. Clin Biochem 2020; 77:32-35.
Hueth KD, Jackson BR, Schmidt RL. An audit of repeat testing at an academic medical center: consistency of order patterns with recommendations and potential cost savings. Am J Clin Pathol 2018; 150:27-33.
Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med 2012; 7:193-199.
Lang T. National Minimum Re-testing Interval Project: A final report detailing consensus recommendations for minimum re-testing intervals for use in Clinical Biochemistry. Prepared for the Clinical Practice Group of the Association for Clinical Biochemistry and Laboratory Medicine and supported by the Royal College of Pathologists: Association of Clinical Biochemistry and Laboratory Medicine; 2013. p.1–36.
Sales MM, Taniguchi LU, Fonseca LA, Ferreira-Junior M, Aguiar FJ, Sumita NM, et al. Laboratory tests ordering pattern by medical residents from a Brazilian University Hospital. Am J Clin Pathol 2016; 146:694-700.
Asim M, Alkadi MM, Asim H, Ghaffar A. Dehydration and volume depletion: how to handle the misconceptions. World J Nephrol 2019; 8:23.
Smellie WS. Time to harmonise common laboratory test profiles. Br Med J 2012; 344:e1169.
Moriles KE, Azer SA. Alanine Amino Transferase (ALT). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jul 2020. Available at: https://pubmed.ncbi.nlm.nih.gov/32644704/. Accessed 20th April, 2020.
Xu Q, Higgins T, Cembrowski GS. Limiting the testing of AST: a diagnostically nonspecific enzyme. Am J Clin Pathol 2015; 144:423-6.
Birindelli S, Pasqualetti S, Panteghini M. Offering Aspartate Aminotransferase as a Reflex Test: An Easy but Effective Way to Improve Appropriateness of Laboratory Requests. Am J Clin Pathol 2018; 149:456-7.
Badrick T, Turner P. Review and recommendations for the component tests in the liver function test profile. Indian J Clin Biochem 2016; 31:21-9.
Cadamuro J, Ibarz M, Cornes M, Nybo M, Haschke-Becher E, von Meyer A, et al. Managing inappropriate utilisation of laboratory resources. Diagnosis (Berl) 2019; 6:5-13.
Kalakonda A, John S. Physiology, Bilirubin. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2020. Available at: https://pubmed.ncbi.nlm.nih.gov/29261920/. Accessed 20th April, 2020.
Lapić I, Rogić D. Frequency of repetitive laboratory testing in patients transferred from the Emergency Department to hospital wards: a 3-month observational study. Diagnosis (Berl) 2020 ;1(ahead-of-print).
Rogg JG, Rubin JT, Hansen P, Liu SW. The frequency and cost of redundant laboratory testing for transferred ED patients. Am J Emerg Med 2013; 31:1121-1123.
Gunashekar D R. (2019). A Report on Programming a Clinical Decision Support Algorithm to Capture Inappropriate Complete Blood Count and Basic Metabolic Panel Lab Orders Using Arden Syntax, a Formalism for Medical Logic Modules. Retrieved rom: The University of Minnesota Digital Conservancy; 2019. http://hdl.handle.net/11299/211310.
Lippi G, Brambilla M, Bonelli P, Aloe R, Balestrino A, Nardelli A, et al. Effectiveness of a computerised alert system based on re-testing intervals for limiting the inappropriateness of laboratory test requests. Clin Biochem 2015; 48:1174-1176.
Sedrak MS, Patel MS, Ziemba JB, Murray D, Kim EJ, Dine CJ, et al. Residents’ self-report on why they order perceived unnecessary inpatient laboratory tests. J Hosp Med 2016; 11:869-872.
Dhanani JA, Barnett AG, Lipman J, Reade MC. Strategies to reduce inappropriate laboratory blood test orders in intensive care are effective and safe: a before-and-after quality improvement study. Anaesthesia and intensive care 2018; 46:313-20.
Gönel A. Clinical biochemistry test eliminator providing cost-effectiveness with five algorithms. Acta Clinica Belgica. 2018; 75:123-127