scholarly journals Effects of a demand optimization intervention on laboratory test utilization in primary care

2019 ◽  
Author(s):  
Magda Bucholc ◽  
Maurice O’Kane ◽  
Brendan O’Hare ◽  
Ciaran Mullan ◽  
Paul Cavanagh ◽  
...  
Keyword(s):  
Laboratory Test ◽  
Financial Incentive ◽  
Clinical Chemistry ◽  
Chemistry Laboratory ◽  
Intervention Package ◽  
Laboratory Service ◽  
Health And Social Care ◽  
Practice Variability ◽  
One Year ◽  
Test Request

AbstractThere is evidence of increasing use of laboratory tests with substantial variation between clinical teams which is difficult to justify on clinical grounds. The aim of this project was to assess the effect of a demand optimisation intervention project on laboratory test requesting by general practitioners (GPs) in an area of Northern Ireland supported by the Clinical Chemistry Laboratory service of Western Health and Social Care Trust (WHSCT). The intervention package was developed in conjunction with the Western Local Commissioning Group and consisted of educational initiatives, feedback to 55 individual practices on test request rates with ranking relative to other practices, and a small financial incentive for practices to reflect on their test requesting activity. Overall test utilization rates of profile tests, HbA1c, and PSA one year before, during, and one year after the intervention were measured using laboratory databases of the Altnagelvin Area Hospital, Tyrone County Hospital, and the Erne (South West Acute Hospital. The intervention was associated with mixed effects. First, we observed a reduction of 5.1% in the median profile test request rates and a decrease in their between practice variability. The overall downward trend in variability of profile test request rates was found statistically significant (p = 0.03). Second, we found a significant increase in both the volume (p < 0.0001) and between practice variability (p = 0.0001) of HbA1c requests per patient with diabetes. The increase in HbA1c requests may reflect a more appropriate rate of diabetes monitoring and also the adoption of HbA1c as a diagnostic test. Yet, the subsequent 600% increase in between practice variability of HbA1c ordering rates may imply an inconsistent implementation of recommended guidelines by GPs. Finally, there was a 29.3% increase in the median and 35% increase in between practice variability of request rates for PSA, the reasons for which are unclear.

scholarly journals A laboratory demand optimisation project in primary care

2018 ◽  
Author(s):  
Magda Bucholc ◽  
Maurice O’Kane ◽  
Brendan O’Hare ◽  
Ciaran Mullan ◽  
Paul Cavanagh ◽  
...  
Keyword(s):  
Primary Care ◽  
Laboratory Test ◽  
Urban Areas ◽  
Financial Incentive ◽  
List Type ◽  
Rural And Urban ◽  
Health And Social Care ◽  
Practice Variability ◽  
The Mean ◽  
Test Request

AbstractBackgroundThere is evidence of increasing use of laboratory tests with substantial variation between clinical teams which is difficult to justify on clinical grounds. The aim of this project was to assess the effect of a demand optimisation intervention on laboratory test requesting in primary care.MethodsThe intervention comprised educational initiatives, feedback to 55 individual practices on test request rates with ranking relative to other practices, and a small financial incentive for practices to engage and reflect on their test requesting activity. Data on test request numbers were collected from the laboratory databases for consecutive 12 month periods; pre‐intervention 2011-12, intervention 2012-13, 2013-14, 2014-15, and post-intervention 2015-16.ResultsThe intervention was associated with a 3.6% reduction in the mean number of profile test requests between baseline and 2015-16, although this was seen only in rural practices. In both rural and urban practices, there was a significant reduction in-between practice variability in request rates. The mean number of HbA1crequests increased from 1.9 to 3.0 per practice patient with diabetes. Variability in HbA1crequest rates increased from 23.8% to 36.6%. At all considered time points, test request rates and variability were higher in rural than in urban areas.ConclusionsThe intervention was associated with a reduction in both the volume and between practice variability of profile test requests, with differences noted between rural and urban practices. The increase in HbA1crequests may reflect a more appropriate rate of diabetes monitoring and also the adoption of HbA1cas a diagnostic test.Strengths & limitations of the studyWe assessed the effect of a laboratory demand optimisation intervention both on the value and between GP practice variability in laboratory test requesting.The changes in laboratory test requesting were separately evaluated for rural and urban GP practices.Other factors (GP practice organisation, characteristics of general practitioners) potentially affecting between practice differences in laboratory test ordering were not taken into account due to data unavailability.The demand management initiative was not accompanied by the cost-effectiveness analysis.The demand optimisation intervention was conducted in a Northern Ireland (NI) Western Health and Social Care Trust and the findings have not been independently replicated in any other NI trusts.

A Pilot Study on the Evaluation of Clinical Chemistry Laboratory Test Performance using Six Sigma Metrics

2019 ◽  
Vol 4 (2) ◽  
pp. 31-36
Author(s):  
Pier Angeli Medina ◽  
◽  
Jenny Matibag ◽  
Sarah Jane Datay-Lim ◽  
Elizabeth Arcellana-Nuqui
Keyword(s):  
Pilot Study ◽  
Laboratory Test ◽  
Test Performance ◽  
Six Sigma ◽  
Clinical Chemistry ◽  
Chemistry Laboratory ◽  
Clinical Chemistry Laboratory

scholarly journals Determination of errors that compromise the quality of laboratory service in a tertiary hospital

2017 ◽  
Vol 8 (1) ◽  
pp. 64-70
Author(s):  
Kenneth Kipruto Kimengech ◽  
Stanley Kinge Waithaka ◽  
Jackson Onyuka ◽  
Christine Sekadde Kigondu
Keyword(s):  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Clinical Chemistry ◽  
Common Knowledge ◽  
Tertiary Hospital ◽  
Chemistry Laboratory ◽  
Laboratory Service ◽  
Laboratory Errors ◽  
Analytical Errors

Background: Clinical Laboratory testing is a highly complex process that entails numerous procedures. Although it has been known that laboratory testing services are safe, it is increasingly becoming a common knowledge that they are not that safe. Studies have indicated that there are a number of errors that occur due to laboratory testing processes. These errors may not be realized easily during the testing process, but they make significant impact on the results given.Aims and Objective: To determine the levels of pre-analytical, analytical, and post analytical errors found in the analysis of Clinical Laboratory specimen at Kenyatta National Hospital.Materials and Methods: A prospective and descriptive study was carried out at Clinical Chemistry Laboratory, Department of Laboratory Medicine, Kenyatta National Hospital. A total of 346 request forms, specimens/samples and dispatched results were scrutinized and errors documented as per the different variables in the different phases, over a period of three months and the findings were analyzed.Results: Results of the study showed that Preanalytical errors were most common with a frequency of 148(42.8%), followed by analytical errors 114 (32.9%) and post analytical errors 84 (24.3%), respectively.Conclusions: The study concludes that pre-analytical, analytical, and post analytical errors are errors that compromise the quality of laboratory service delivery, which impacts on the patient management and diagnosis. Clinical laboratory errors can be minimized if due diligence and professionalism is adhered in the laboratory.Asian Journal of Medical Sciences Vol.8(1) 2017 64-70

A Punched-Card System for the Laboratory

1962 ◽  
Vol 8 (5) ◽  
pp. 538-545 ◽  
Author(s):  
Nathan Radin
Keyword(s):  
Clinical Chemistry ◽  
Laboratory Data ◽  
Chemistry Laboratory ◽  
Test Card ◽  
Clinical Chemistry Laboratory ◽  
Original Laboratory ◽  
Numerical Order ◽  
Card System ◽  
A Charge ◽  
Laboratory Record

Abstract A punched-card system was developed to simplify the administrative aspects of the clinical chemistry laboratory. In it a three-part requisition and samples are matched and given a laboratory number. The third copy of the original laboratory requsition is a charge card also used as a name file for the day. Prepunched cards, coded for laboratory tests, are used for each test requested. The laboratory number is stamped and punched on each test card. All test cards are then sorted into laboratory test groups, after which the laboratory data and results are recorded on them. Cards are then sorted for laboratory number and rematched with the original laboratory requisitions, which remained in numerical order. Results are then copied directly onto the requisitions. The system is more efficient, less susceptible to error, and simpler than other laboratory record systems.

Simulation of a clinical chemistry laboratory

1983 ◽  
Vol 14 (3) ◽  
pp. 301-316
Author(s):  
ARVIND K. N. NANDEDKAR ◽  
A. BLANK ◽  
JACOB ROOTENBERG
Keyword(s):  
Clinical Chemistry ◽  
Chemistry Laboratory ◽  
Clinical Chemistry Laboratory

Hyperalimentation Laboratory Support

PEDIATRICS ◽  
1982 ◽  
Vol 69 (6) ◽  
pp. 833-833
Author(s):  
Joe Rutledge ◽  
Larry Miller
Keyword(s):  
Pediatric Patients ◽  
Clinical Chemistry ◽  
Serum Triglyceride ◽  
Chemistry Laboratory ◽  
Therapeutic Monitoring ◽  
Fat Emulsion ◽  
Serum Fatty Acid ◽  
American Academy Of Pediatrics ◽  
Clinical Chemistry Laboratory ◽  
Intravenous Fat Emulsions

The Committee on Nutrition, American Academy of Pediatrics has recently reported on the "Use of Intravenous Fat Emulsions in Pediatric Patients" (Pediatrics 68:738, 1981). The committee recommends restriction of the amount of fat emulsion given infants because of a lack of accurate and appropriate means of monitoring serum fatty acid and triglyceride concentrations. Such is not the case for triglycerides. The pediatric clinical chemistry laboratory has the ability to measure serum triglyceride concentrations to support hyperalimentation therapeutic monitoring.

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