Ann Lab Med 2018; 38(5): 402-412  
Reducing Test Utilization in Hospital Settings: A Narrative Review
Renuka S. Bindraban, M.D.1,2, Maarten J. ten Berg, Ph.D.1, Christiana A. Naaktgeboren, Ph.D.1,3, Mark H.H. Kramer, Ph.D.2, Wouter W. van Solinge, Ph.D.1, and Prabath W. B. Nanayakkara, M.D.2
Departments of Clinical Chemistry and Haematology1, University Medical Center Utrecht, Utrecht, The Netherlands; Section Acute Medicine, Department of Internal Medicine2, VU University Medical Center, Amsterdam, The Netherlands; Julius Center for Health Sciences and Primary Care3, University Medical Center Utrecht, Utrecht, The Netherlands
Corresponding author: Prabath W. B. Nanayakkara
https://orcid.org/0000-0002-1555-3682
Section Acute Medicine, Department of Internal Medicine, VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
Tel: +31-204444444, Ext: 6791
E-mail: p.nanayakkara@vumc.nl
Received: November 2, 2017; Revised: January 23, 2018; Accepted: May 6, 2018; Published online: September 1, 2018.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Studies addressing the appropriateness of laboratory testing have revealed approximately 20% overutilization. We conducted a narrative review to (1) describe current interventions aimed at reducing unnecessary laboratory testing, specifically in hospital settings, and (2) provide estimates of their efficacy in reducing test order volume and improving patient-related clinical outcomes.
Methods: The PubMed, Embase, Scopus, Web of Science, and Canadian Agency for Drugs and Technologies in Health-Health Technology Assessment databases were searched for studies describing the effects of interventions aimed at reducing unnecessary laboratory tests. Data on test order volume and clinical outcomes were extracted by one reviewer, while uncertainties were discussed with two other reviewers. Because of the heterogeneity of interventions and outcomes, no meta-analysis was performed.
Results: Eighty-four studies were included. Interventions were categorized into educational, (computerized) provider order entry [(C)POE], audit and feedback, or other interventions. Nearly all studies reported a reduction in test order volume. Only 15 assessed sustainability up to two years. Patient-related clinical outcomes were reported in 45 studies, two of which found negative effects.
Conclusions: Interventions from all categories have the potential to reduce unnecessary laboratory testing, although long-term sustainability is questionable. Owing to the heterogeneity of the interventions studied, it is difficult to conclude which approach was most successful, and for which tests. Most studies had methodological limitations, such as the absence of a control arm. Therefore, well-designed, controlled trials using clearly described interventions and relevant clinical outcomes are needed.
Keywords: Laboratory utilization, Laboratory testing, Unnecessary laboratory utilization, Unnecessary laboratory testing, Reduction, Intervention



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