PubMed · 12778947
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Kathy Hansen, Don Lavanty. 2002. Waived testing.. https://pubmed.ncbi.nlm.nih.gov/12778947/
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New and expensive treatments, introduction of difficult to interpret complex tests, a greater reliance on nurse practitioners as deliverers of primary care and patient initiated testing, all make it likely that in the future greater emphasis will be placed on appropriate use of cost-effective laboratory tests. The most promising solution to inappropriate utilization of laboratory services is a greater reliance on clinical laboratory consultants. At present, many laboratory physicians and scientists cannot compete with specialist physicians in terms of the ability to provide credible helpful advice on test selection and results interpretation. Educational prerequisites to effective consultation are: understanding of disease pathogenesis, knowledge of clinical problem solving and identification with clinical questions. The latter requires clinical experience or intensive training in clinical laboratory consultation. Further barriers to implementation of comprehensive laboratory consultation services include resistance on the part of practicing physicians, health care administrators and insurers. Whether these barriers can be overcome or not, the future will include comprehensive laboratory consultation services conducted through web-based access to advice on test selection and interpretation of results.
BACKGROUND: External reviews and the accreditation of medical laboratories involve more than the mere assessment of conformance with standards for organisational processes. The new approaches to quality improvement suggest that, rather than using inspection to correct unusual errors, there should be more emphasis on improving the processes of health care to ensure that desired outcomes are produced. Appropriateness plays a key role in programs for quality improvement. METHODS: Appropriateness in laboratory medicine can be assessed, and improved, through the governance of the entire testing process. This begins with test selection, proceeds through valuable pre-, intra- and post-analytical procedures, and concludes by assuring the correct interpretation and utilization of laboratory information. RESULTS: The International Standard, specifically developed for medical laboratories (ISO 15189) recognizes the value of appropriate interpretation and advisory services, although it does not specify requirements for assessing appropriateness, requesting tests and interpreting results. The effectiveness of clinical laboratories can be assessed by using surrogate markers, which indicate physicians' satisfaction, and clinical audits. Effectiveness is also enhanced by stressing the importance of the technical and professional competence of evaluators. CONCLUSIONS: Inappropriate laboratory utilization unjustifiably increases health care costs, can harm patients and perpetuates the vision of laboratory testing as a commodity. Improvement in laboratory appropriateness can be achieved by seeking a better relationship with physicians and by stressing the role of laboratory specialists in providing clinical advice for the selection of laboratory tests, and the interpretation and utilization of their results, thus leading to more satisfactory clinical outcomes.