Introduction
Laboratory testing is one of the major and important component of medical diagnosis. However, unrationalised laboratory test ordering may lead to misdiagnosis of diseases, which would delay treatment of the patients. It would also lead to wasting the laboratory resources that adversely impact the hospital budget.1
Kobewka et al reviewed numerous international studies and concluded that a considerable proportion of the laboratory tests performed were unnecessary and did not contribute to patient care.2 Introducing effective and sustainable solutions for the optimal use of laboratory testing in clinical practice is a challenge. Our project focused on increasing the awareness about appropriate laboratory testing with an aim to change the mindset of physicians.
Inappropriate and excessive use of laboratory testing has multiple reasons but, some of the major ones include practising defensive medicine by ordering a barrage of tests for all patients to avoid any litigation issues, medical malpractice, lack of knowledge of the value of ordered laboratory tests, and patients pressure for proactive testing.3–5
Additionally, ‘demand management’ may be misunderstood as a reduction in ordering laboratory tests, whereas, on the contrary it simply implies to ordering the appropriate test. It could subsequently lead to an increase or decrease testing depending on the good medical sense and practice of the attending physician.6
Problem description
Unnecessary and excessive laboratory test requests for a patient affects patient care. It may lead to delay in correct diagnosis, misdiagnosis and faulty treatment, needless follow-up testing and appointments, prolong hospital admission stay, and unwarranted stress to the patient. Perhaps, out of all these, the most significant is risk to patient safety due to incorrect or delayed diagnosis.7 Apart from jeopardising the patient’s safety, another very relevant consequence of inappropriate laboratory test ordering is the immense financial burden incurred to the hospital budget and ultimately National Health Services.8
Armed Forces Hospital Jizan (AFHJ) is a 70-bedded hospital located in the outskirts of Abu Arish. It has a dedicated laboratory service that provides comprehensive services 24/7 for all the patients using the hospital facility. During 2017, 2018 and 2019, the average number of laboratory tests ordered from just 12 different medical specialties in our hospital were 603 155–709 595 and 788 438, respectively. The overall average for these three years was 700 396 laboratory tests.
We collected the annual consumption of ordered laboratory tests and categorised it according to frequency of testing, cost and the requesting department. This facilitated in targeting the tests can be managed and controlled. It was found that the most frequent tests with a high cost were HbA1c, TSH, FT4, FT3, FSH, LH and PRL. Therefore, our project rationale was to study the efficacy of rationalisation of laboratory tests ordering and their consumption as a part of quality improvement (QI) project at AFHJ, Kingdom of Saudi Arabia (KSA).
Aim
The aim of this project was to rationalise laboratory tests ordering and ensure effective utilisation of resources at AFHJ by a 10% reduction in selected pathology tests (HbA1c, TSH, FT4, FT3, PRL, FSH and LH) in the targeted clinics by the end of December 2021.