Laboratory Test requesting Appropriateness and Patient Safety
Description
The global medical process is a chain of different medical multidisciplinary procedures. The success in global Patient Safety will depend on the Safety of the consecutive medical processes that intervene in this complex system. Laboratory data is an essential part of health care, indeed it is used in 70% of clinical decisions. Inappropriate laboratory test over requesting is extremely frequent. The prevalence of under requesting has been less studied. The consequences of under requesting are clear, we are missing a diagnosis. Inappropriate over requesting can result not only in a problem of cost but also in a problem regarding patient safety. Additionally, another important consequence of inappropriate tests over requesting is that such amount of unnecessary tests has probably contributed to a significant increase in the volume of those over the last years. In all, there is general consensus that the inadequacy of test requesting must be corrected through strategies and monitored over time through indicators to assure the optimal laboratory contribution to clinical decision-making and patient safety.
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Content
- Intro
- Preface
- Table of contents
- 1 Introduction: clinical laboratory contribution to patient safety
- References
- 2 Inappropriateness in laboratory test requesting in the literature
- 2.1 Laboratory process-test request
- 2.2 Definition of inappropriate requests
- 2.3 Causes of inappropriate test requests
- 2.3.1 Laboratory
- 2.3.2 Requesting physician
- 2.3.3 The patient
- 2.3.4 Factors inherent in the system
- 2.4 Reducing inefficiency in the laboratory diagnostic process
- 2.5 Tools described in the literature for the management of the demand for laboratory tests: before, during, and after the request
- 2.5.1 Before
- 2.5.2 During the request
- 2.5.3 After the request
- 2.6 The future: where we are going
- References
- 3 Causes and negative effects of inappropriateness in laboratory test requesting
- 3.1 Introduction
- 3.2 Causes of inappropriateness in laboratory test requesting
- 3.2.1 Clinician's unawareness about the test
- 3.2.2 Communication between clinical and laboratory departments
- 3.2.3 Others
- 3.3 Negative effects of inappropriateness in laboratory test requesting
- References
- 4 Strategies to correct inappropriateness in laboratory test requesting
- 4.1 Introduction
- 4.2 Types of strategy to correct inappropriateness in laboratory tests
- 4.2.1 Strategies based on education, audit, and feedback
- 4.2.2 Rules and agreements aimed at vetting test requests
- 4.2.3 Re-design of the request formularies
- 4.2.4 Computer physician order entry
- 4.3 Strategies to correct inappropriateness in laboratory test requesting and phase of intervention
- 4.3.1 Pre-requesting phase interventions
- 4.3.2 During requesting interventions
- 4.3.3 Post-requesting interventions
- 4.4 Laboratory medicine
- 4.5 Epilogue
- References
- 5 Practical pathway to design, establish, and monitor over time test requesting appropriateness strategies: indicators to detect the inappropriateness and to monitor after interventions
- 5.1 Introduction
- 5.2 The plan-do-check-act cycle as a basis in the design of strategies to correct inappropriateness in laboratory test requesting
- 5.3 Indicators that intervene in strategies to correct inappropriateness in laboratory test requesting
- 5.3.1 Indicators in clinical laboratory: general considerations
- 5.3.2 Indicators to detect test inappropriateness and to monitor after the establishment of the different interventions
- 5.4 A step-by-step description of strategies to correct inappropriateness in laboratory test requesting
- 5.4.1 Identify laboratory test inappropriateness
- 5.4.2 Selection of the test and target population
- 5.4.3 Generation of the idea
- 5.4.4 Pre-design of the strategy
- 5.4.5 Strategy final design
- 5.4.6 Strategy establishment
- 5.4.7 Monitoring through process indicators
- 5.4.8 Evaluation through outcome indicators
- 5.4.9 Final decision whether to continue or stop the strategy
- References
- 6 Potential of computer physician order entry (CPOE) to improve patient safety related to laboratory test requesting
- 6.1 What is a computer physician order entry (CPOE) system?
- 6.2 CPOE interventions
- 6.3 Design strategies
- 6.3.1 Re-design of the request formularies
- 6.3.2 Use of clinical (or "disease-specific") profiles/panels
- 6.3.3 Customized formularies
- 6.3.4 Display costs/fees
- 6.3.5 Search functions
- 6.3.6 Research/clinical trial formularies
- 6.4 Clinical decision support rules
- 6.4.1 Specialty/staff-grade limitations
- 6.4.2 Minimum retest intervals
- 6.4.3 Asking for additional information: questions
- 6.4.4 Suggestions/corrections
- 6.5 CPOE advantages in pre-analytical phase
- 6.6 Conclusions
- References
