Laboratory Utilization

The clinical laboratory has an important and expanding role in ensuring that laboratory tests are appropriately utilized in clinical practice. Utilization management is a strategy to ensure that the appropriate laboratory tests provide high-quality and cost-effective patient care.

With increasing pressure to cut costs, coupled with increased testing demand, it is critical that testing guidelines, standards of practice and consultation with users of service inform appropriate utilization.

Numerous test utilization initiatives have been implemented over the past few years within the Department of Pathology and Laboratory Medicine at Capital Health. A Laboratory Utilization Committee (LUC) was established in November 2010 to monitor, review and evaluate the different utilization initiatives within the Department.
Utilization measures may include:

  • Review of ordering practices with physicians. This includes:
    • an evaluation and approval process for requests to add a test to the Laboratory’s testing menu, including expensive referred-out tests as well as new in-house testing;
    • the appropriate indication and provision of alternate testing, to be discussed with ordering physicians.
  • Evaluation of requirements for implementation of cancellation rules based on test performance and clinical criteria.  Laboratory tests are reviewed regularly and utilization guidelines applied where appropriate. Cancellation rules may be based on:
    • testing algorithms or on the time since previous testing. Tests may be automatically cancelled when repeat testing is requested within established time period; e.g., HgB A1c ordered within 80 days of last Hgb A1c results. For details see Cancel Rules Repeat Testing Intervals.
    • specimen’s timeframe from collection to testing. Tests may be automatically cancelled when the specimen collection timeframe is beyond established guidelines. For details see Cancel Rules Specimen’s Maximum Hours from Collection to Testing.
    • guidelines and standards of practice.
  • Auditing of individual physician ordering practices in comparison to a peer group.