Can I be brutally honest from the very beginning?
If your answer is NO, then it’s better you stop reading immediately.
I won’t tell you: “You have something black on your teeth”. If you work in a laboratory, this what I will tell you now is much more painful than that. It’s so direct and unexpected that I’m actually risking the future of our entire relationship.
I’ve been keeping it for myself for the past two years, hoping that someone else will do the “dirty work” instead of me. Unfortunately, no one did. Out of respect for your effort, I must say the truth, so here it is…
… At least a third of results in your test results sheets is GARBAGE.
Yes, you’ve read GARBAGE, pardon my french.
It’s not because you didn’t calibrate your analyzer that one time, you probably have a good reason for it. And it’s not because your laboratory doesn’t comply to each tiny detail the ISO standard demands, none of them does.
The reason for that is a core reason.
A large amount of tests ordered is WRONG.
NUMBER 1. PROBLEM!
Misusing laboratory diagnostics is the #1 problem for laboratories. You can have a laboratory with internal processes perfectly set up, but perfect processes don’t mean much if you’re using them for tests that won’t help the process of diagnosis and treatment.
Every lab performs 10% to 50% of unnecessary tests. Back when I insulted you by saying that the third of your results is GARBAGE, actually I compared you to Mayo Clinic Laboratories and Arup Laboratories.
Approximately, a third of the tests performed by these two top laboratories were actually unnecessary tests, in other words, tests performed in situations where there was no real need for those tests.
We have two main categories of laboratory test inappropriate usage:
1. EXCESSIVE TESTING
Here, we’re mostly talking about tests which are repeated without a reason, or “ordered” without the appropriate clinical indications.
You don’t need an awful lot of imagination to notice the direct influence of “wrong tests” on the budget of the healthcare system. And the laboratory is a part of that healthcare system. The money spent on unnecessary testing = The money that could’ve been spent on something that could realistically improve patient’s health.
The story doesn’t end there, these wrong tests incline doctors to order additional, more expensive tests. In the end, the patient ends up being a victim of an unnecessary ionizing radiation or, in best case scenario, gets a few new pinpricks.
2. INSUFFICIENT TESTING
Impacts of this phenomenon is harder to measure, and it usually happens due to lack of some important tests in the testing process.
In short-terms it saves money, but in long-terms, it has catastrophic influence on patient’s health and treatment cost. Studies show that in approximately 30% of cases doctors fail in ordering the appropriate test.
Those missed tests make us blind to the key changes in the patient’s health condition. They have a direct influence on diagnosing a disease too late, or missing to diagnose the disease completely.
I’ve personally experienced the seriousness of this problem. Series of laboratory results indicated that my health condition was good as Tarzan’s, but in fact, I was seriously ill and just a step away from dying.
IT’S NOT OUR TASK TO THINK ABOUT THAT, OR…
“We cannot solve our problems with the same thinking we used when we created them.” – Albert Einstein
I know you are aware of these problems. Every day you receive orders that make no sense to you. The goal of this post isn’t to “point the finger” at those who are responsible for this, but to make steps together towards the solution.
First step is also the hardest one, it demands something no man likes. And that is questioning the system in which we feel so comfortable. On the image below, we can clearly see the simplified process flow, from order to results.
Historically, laboratories are mostly focused on analytical processes (colored in green on the image). Other phases are explicitly in the hands of the clinic departments.
And where do errors mostly occur you wonder?
Exactly in those sections of the process that aren’t controlled by the laboratory.
Pre-analytic and post-analytic phase (colored in blue on the image) causes the majority of “laboratory” errors, from increasing our therapeutic TAT to making us perform test that won’t aid the treatment.
Traditional medical system is built around the assumption that people from the laboratory shouldn’t interfere with processes outside their laboratory. But, if we want to solve the issues that cause deterioration of patient’s health, we need to get involved in processes outside our labs.
Time showed that doctors can’t cope with this task by themselves. Laboratory experts are in the best position to help them. The idea is simple – Laboratory isn’t just a value on the laboratory results report.
EVERY PROBLEM HAS A SOLUTION
“Laboratory tests utilization management mandates organizations to substantiate the medical necessity, appropriateness, and efficiency of laboratory services for their patients.” – Tim Kuruvilla, Viewics Inc
Laboratory test utilization management is a relatively “new discipline”. In essence, it is a mutual effort of clinical and laboratory experts to properly utilize laboratory tests.
We’re talking about establishing mechanisms for cooperation, preventing errors in pre-analytical and post-analytical phases.
World leading laboratories in USA, Europe and Asia have already been using these methods for the past couple of years. There are many exemplary laboratories, but I will name only few in this post.
|Bronson Methodist Hospital reduced the number of tests in their laboratories from 4700$ to 2450$ per month. This change showed no negative effects on their patients’ health condition.|
|Arup Lab is a reference laboratory that completely adjusted their business philosophy in favor of performing correct tests. Their studies showed a decrease of 28% in tests performed for their clients.|
There are many strategies that can bring appropriate results, and we will write about them in detail in our next blog posts, and these are some of them:
- Changes in the process of selecting and ordering tests
- Smarter approach to the process of introducing new tests
- Adjustments in the reception section of the LIS
- Developing mechanisms for communication with doctors in the post-analytic phase
- Developing rules for personalized approach to patients
IS MY LABORATORY RIGHT FOR THIS?
Some of these strategies sound complicated and unattainable in your environment, and maybe you’re right. But, this is only one of the strategies for solving the problem.
If you want to check whether your lab can improve ordering and utilization of tests, fill out this simple survey . Ideally, you will share this survey with all of your lab employees, because it would increase the relevance of the survey results.
Regardless of your laboratory type, strategic advancement in this direction will help you in launching your laboratory to a higher level. Based on the responses on our survey, we will send you simple steps which can guide your efforts in the very beginning.
When it comes to the health of patients, even the smallest advancements can lead to big victories.