CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Amylase blood testing is a similar case. Serum lipase is now the preferred test in cases of suspected acute pancreatitis, Dr. Schifman says, so labs can expect to see a higher number of lipase tests compared with amylase tests. “If we find that inpatient test volume is about equal in some facilities, this information could identify an opportunity to minimize ordering practices for lipase and amylase.” That might be reconfiguring a menu that contains both tests coupled as a single order. Or it could be that education is what is needed, “or there may be other opportunities for labs to adjust their ordering systems.”
In past Q-Probes that have focused on test utilization, the data were likely more difficult to collect, says Dr. Schifman, citing studies of repeat genetic testing and free PSA and hepatitis A testing. For those studies, “You had to look at results, and you had to see if the same test was ordered on the same patient,” he says. The new study follows a different and simpler strategy.
“This study has a different and easier data collection method. All the laboratory has to do is extract annual test volume for a variety of tests, which most laboratory information systems can do very easily for inpatients,” he says. The study also asks for the number of inpatient days per year, which health information or medical records departments typically keep track of, and there’s a short questionnaire on test ordering practices. “The study happens to be relatively easy to conduct,” he says, and it’s his view that the benefits will “strongly outweigh the time it will take to collect this information.” Participating labs will know which inpatient testing practices are in control, he says, and which ones can be adjusted for downstream improvements.
“What we’re really looking for are extreme outliers,” Dr. Schifman says of inpatient test volumes. But he predicts that the more likely outcome for the majority of the analytes in the study is that laboratories will be clustered within a relatively narrow range of ratios. “And that’s a good thing.” Knowing that inpatient testing practices aren’t in need of intervention, he says, is just as valuable for laboratories as learning that an intervention is needed. “That means their testing practices seem to be pretty well aligned with everyone else, and that would be the best outcome. They wouldn’t need to do any interventions at all.”
The study aims to account for variations in intensity of testing, Dr. Schifman says. “We are going to collect data about the general percentages of patients that are acute care, chronic care, and critical care to account for some of the variation, and that will affect to some degree the volume of testing. But since we’re focusing on extreme outliers, such as 10 times higher than the median of a lab’s peer group, that finding would not be caused by levels of care alone.”
The study will be valuable for laboratories that haven’t tackled inpatient test utilization, for labs that are starting to do so, and even for those further along, Dr. Perrotta says. “You will require resources for your test utilization activities, and having this kind of data on hand can help you get the help you need from your organization.”
Many hospitals have a test utilization or lab stewardship committee, and in some hospitals labs report their stewardship activities to C-suite or executive committees. It would be helpful, Dr. Schifman says, to be able to say, ‘“We participated in this study and looked at our inpatient test utilization practices, and using this methodology, we don’t seem to have any significant issues to address.’”
Laboratories that have a test utilization structure in place—a utilization team whose members are from all pertinent hospital areas—will be able to make decisions on the fly more easily when it’s necessary, Dr. Perrotta says. “You’re able to quickly make changes to your IT system. You’re already monitoring test volume, so it’s easy to inform leadership how many tests have been performed each day. I think it’s very valuable to organizations during these unusual times.”
Charna Albert is CAP TODAY associate contributing editor. To order, call 800-323-4040 option 1 (international calls: 001-847-832-7000 option 1) or go to www.cap.org (click on Shop, Quality Management, 2020 Q-Probes, QP203).