With these 6 factors, failure in laboratory test utilization is guaranteed

6 factors why laboratory utilization fails
How often do you carry out unnecessary tests?

Multiply the number you thought of by 5, and you are probably close to the correct number.

In one of our previous posts, we said that performing unnecessary and incorrect tests is the main problem laboratories are facing.

The truth is, doctors are holding the “ordering stick” and the biggest responsibility lies on their back. In no way does that mean they are the only ones responsible for this malignant phenomenon in healthcare.

Performing unnecessary laboratory tests is caused by many factors, and I’ll mention the most important ones.

1. MEDICAL (UN)EDUCATION

Any one of you who works in a laboratory can understand this. Doctors often have weird patterns for ordering tests.

The enigma of this phenomenon is yet to be fully discovered, but we already have some data which will ease up our reflection on it.

Even though doctors can spend a lot of time ordering tests, they spend a surprisingly
short amount of time on learning how to properly order and interpret tests.

  • Only 9% of medical universities have a specifically defined “course” for laboratory diagnostic
  • On medical universities, students spend approximately 10 hours learning how to order and interpret lab tests
  • On some universities, it’s even less than 5 hours

So, doctors learn “on the move” how to order tests from people who also learned “on the move” 30 years ago. As it’s probably clear to you, this isn’t really a formula for success.

2. A LOT OF PAPERS = A LOT OF ERRORS

When we implemented our WizardLab (Laboratory Informational System) in a large university hospital, already on the first day we received a “hot call” from the laboratory manager.

a worried man

Photo: illustration

“How is it possible that today, one of our patients was tested 4 times for the same analysis?”

At first, even we thought it was a system error, but after we checked it turns out that it wasn’t a system error.

The patient walked from one specialist to the other, generously giving blood for testing, in belief that it’s completely normal to do so.

I admit, this is a specific case, but these and similar things slip by when your laboratory is “on the paper”.

Besides these extreme cases, it’s quite often that these kind of errors to occur when the laboratory isn’t computerized.

3. DEFENSE, DEFENSE

We have already established when it comes to ordering laboratory tests, there is a big gap between how much doctors know, and how much they should know. But also, there are other factors “pressing” doctor’s habits.

Back in 1979, Joseph E. Hardison from the Emory University School of Medicine wrote a great article in The New England Journal of Medicine about what exactly influences doctors while making test orders.

At the time, he spoke about the excuses doctors use when ordering tests. Even though it’s been over 35 years since, some of these excuses are nowadays more relevant than they were at that time:

  • Excuse “I’ll get into trouble if I don’t order” – is manifested in situations when a student or a young doctor fears “how will their superior doctor react if they don’t order AFT for every patient”
  • Excuse “ready to go fishing” – i.e. I have no idea what’s wrong with the patient, but if I order laboratory tests, maybe something comes up (in cases where the one who’s ordering the tests doesn’t know what he’s looking for, the thing he finds will usually only mislead him).
  • Excuse “lawsuit” – these are the situations where doctors order tests only to protecting themselves from a potential lawsuit, and not necessary for the patients well-being.

By looking at these excuses, we can clearly see that ordering tests often isn’t initiated by clinical indications and mandatory protocols. Sometimes, it’s a consequence of fear or one’s need to defend himself from someone, or something.

4. ALL AT ONCE

One of the main causes of excessive using is irregular test grouping. Carry out 10 tests when you really need just one, perform 500 tests when you actually need 10, and it all ends up with the popular mantra: “the more, the better”.

Examples of these packages and enormous panels are all around us, from “wellness” tests up to tests for diagnosing risks of developing a heart disease.

Best example of this kind of test grouping are allergy tests. If you ever wondered how’s it possible that every single child allergic to something, then we have the answer for you.

Even though most of allergies (to food and inhalation allergies) can be diagnosed using approximately 10 allergens, in 50% of cases, approximately 20 allergens are ordered in the diagnostic process, and sometimes even over 400 allergens are used.

chart of alergens

Range of allergens

Let’s be realistic, health isn’t black and white, and often health and disease overlap. If you perform “too wide” testing, it’s hard to believe you’ll avoid being falsely positive on some of those tests.

5. EVERYONE CAN ORDER

Depending on the laws of each country, different subjects can order laboratory tests. In some countries, patients have the option to choose tests for themselves.

I’m not saying it’s impossible for patients to learn how to order the appropriate test. If you have the desire and time you can use “Google” to find and learn almost everything.

But, in majority of situations, patients won’t be inspired by an algorithm for ordering test and the protocol they learned. They’ll be inspired by a commercial they saw on TV or “Facebook”.

Even if they have no right to personally order tests, they’ll pressure their doctors to “push the button” for them.

It’s not only the patients who can order tests, seems like almost everyone can do it. Nurses, pharmaceutical workers, everyone except those who work in a laboratory 🙂

6. “WHY WOULD I CARE” LAB Lab

Incorrect test ordering and errors in their interpretation are among the 3 “laboratory” errors with the worst impact on patient’s health.

Do you know why?

Doctors cannot handle these tasks on their own. We already mentioned that in this post. The only way to solve this problem is to somehow include lab staff into test ordering and interpretation phases.

Some are already aware of this, and they are trying to make an impact to make positive changes as much as they can, in their respected fields. Others are completely uninterested to find out how the results on their reports influence patients health, and I personally call them “why would I care” laboratories.

These are the two most common types of “why would I care” laboratories:

  1. Private laboratories that see themselves as strictly commercial laboratories, and they don’t care about value, they care only care about quantity.
  2. Hospital laboratories unwilling to think outside the traditional laboratory=factory approach.

Wrap-up

It’s a popular belief that doctors are the only ones to blame for errors in ordering and interpretation of tests, but that’s far from the truth.

All participants in this process have their share of responsibility in this problem, starting with patients that put pressure on their doctors, to laboratory staff unwilling to “step out of the basement”.

If we take a look at these 6 factors, we can clearly recognize those who can be influenced.

In our future posts we’ll talk about how, with appropriate technological support, laboratory leaders can develop and excellent cooperation with their colleagues in clinic departments. By doing so, they can impact on better test ordering.