Impact of Laboratory Test Use Strategies in a Turkish Hospital

RESEARCH ARTICLE Impact of Laboratory Test Use Strategies in a Turkish Hospital Fatma Meriç Yılmaz1*, Rabia Kahveci2, Altan Aksoy3, Emine Özer Kucuk2, Tezcan Akın4, Joseph Lazar Mathew5, Catherine Meads6, Nurullah Zengin7 1 Yildirim Bayezid University, Department of Biochemistry, Ankara, Turkey, 2 Ankara Numune Training and Research Hospital, Health Technology Assessment Unit, Ankara, Turkey, 3 Ankara Numune Training and Research Hospital, Department of Microbiology, Ankara, Turkey, 4 Ankara Numune Training and Research Hospital, Department of General Surgery, Ankara, Turkey, 5 Advanced Pediatrics Centre PostGraduate Institute of Medical Education and Research, Chandigarh, India, 6 Brunel University, Health Economics Research Group, Uxbridge, United Kingdom, 7 Ankara Numune Training and Research Hospital, Department of Oncology, Ankara, Turkey * Abstract a11111 Objectives Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs. Methods OPEN ACCESS Citation: Yılmaz FM, Kahveci R, Aksoy A, Özer Kucuk E, Akın T, Mathew JL, et al. (2016) Impact of Laboratory Test Use Strategies in a Turkish Hospital. PLoS ONE 11(4): e0153693. doi:10.1371/journal. pone.0153693 Editor: Gianni Virgili, University of Florence, ITALY A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months. Received: June 1, 2015 Results Accepted: April 3, 2016 Copyright: © 2016 Yılmaz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6–85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars. Data Availability Statement: All relevant data are within the paper. Conclusion Published: April 14, 2016 Funding: These authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist. Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests. PLOS ONE | DOI:10.1371/journal.pone.0153693 April 14, 2016 1 / 11 Impact of Laboratory Test Use Strategies in a Turkish Hospital Introduction Reducing healthcare costs, with the maintainance of patient safety and improved quality, is one of the main targets in most healthcare reform efforts. It is often difficult to decide how to achieve this goal. Eliminating unnecessary laboratory tests and procedures is one good place to start. It has been reported that approximately $6.8 billion of medical care in the United States has involved unnecessary testing and procedures that do not improve care and may even harm the patient [1]. The American Society for Clinical Pathology dedicated their April 2012 edition of Critical Values to the issue of appropriate laboratory testing, and pointed out the aim as ‘‘right test, right patient, right time, at the right cost” [2]. It is important to prioritise hospital-based strategies to reduce healthcare costs. ANHTA is the first hospital based Health Technology Assessment (HTA) Unit in Turkey. The unit aims to support hospital managers in evidence-based investment or disinvestment decisions regarding health technology use in the hospital. Hospital based committees, including laboratory professionals and clinicians, can define hospital based problems, which can lead to standardized approaches. Hospital based HTA units have a crucial role in working with the related professionals to facilitate an evidence-based approach in the process, which would further lead to improved quality with reduced costs. In this study, our aim was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate impact and potential savings in health-care costs. Methods A collaborative action plan was defined by the hospital managers. Joint meetings with ANHTA and laboratory chairs were set; the joint committee invited relevant staff for input, and hospital laboratory efficiency committee was created, including clinicians from internal medicine, general surgery, family medicine, emergency department and the laboratory directors of biochemistry and microbiology departments. Literature was reviewed in order to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local setting were identified for implementation, processed and impact on clinical use and costs was assessed for 12 months. Implementations were decided and processed as detailed below: Taking a picture about the current status and increasing the awareness 1. A hospital meeting was conducted in order to create an awareness and the doctors from various departments were informed about the appropriate use of laboratory tests. The examples of the overused tests were shared and discussed during the meetings. The impact of the laboratory costs, the potential harms of ordering an unnecessary test for a patient, the importance of increasing the clinician-laboratory interaction was emphasized. 2. A follow up procedure was planned and a laboratory use report, including mean number of ordered tests per patient and total laboratory cost of every department was prepared. Laboratory use reports were sent to the departments every month. 3. A review was performed to understand how various laboratory tests were used and whether the use was appropriate according to the guidelines or evidence provided in the literature. PLOS ONE | DOI:10.1371/journal.pone.0153693 April 14, 2016 2 / 11 Impact of Laboratory Test Use Strategies in a Turkish Hospital Literature search a (...truncated)