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Demand management and optimization of clinical laboratory services in a tertiary referral center in Saudi Arabia

Thomas F. Morris,a Tracy Louise Ellison,a Maysoon Mutabagani,a Sahar Isa Althawadi,a Martin Heppenheimerb

From the aDepartment of Pathology and Laboratory Medicine and bHealth Informatics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

How to cite this article:

Morris TF, Ellison TL, Mutabagani M, Althawadi SI, Heppenheimer M. Demand management and optimization of clinical laboratory services in a tertiary referral center in Saudi Arabia. Ann Saudi Med 2018; 38(4): 299-304.  DOI: 10.5144/0256-4947.2018.299


BACKGROUND: Demand for clinical laboratory services in our institution has increased by 7% each year in the past 5 years, while the amount budgeted for services has remained fixed. To address the issue, we conducted a pilot study to curb inappropriate demand by implementing a minimum retest interval (time-based restrictions on the ordering certain tests) and thus reduce costs.


OBJECTIVE: Explore the impact (financial and work volume) of restricting overuse of laboratory tests that add to costs but provide no additional clinical value.


DESIGN: Pilot study of means to reduce costs and workload.


SETTING: Clinical laboratory that provides diagnostic support to a tertiary care center specializing in transplantation and oncology.


METHODS: With the engagement of clinical colleagues, we selected 13 tests characterized by high volume, high cost, or a perception of overuse that adds no clinical value. The selection was also based on established lock-out frequencies identified in a literature review. Data was captured on test numbers before and after initiating computer-based lock-outs along with the reference laboratory cost of these tests for the first 6 months of 2016 and 2017. 


MAIN OUTCOME MEASURES: Alterations in testing patterns (mimimum retest intervals) and frequencies for tests.


RESULTS: The number of tests ordered during the 6-month period in 2017 were reduced by an average of 6.6% versus the same period for 2016, saving 2.03 million Saudi Arabian Riyals (SAR). Given a 7% annual growth in the preceding 5 years, the volume was reduced by 13% in real terms. The percentage reduction in number of tests ranged from as little as 0.2% for PT to 70.3% for an enzyme immunoassay. Savings were 1.4 million SAR in hematology and 0.36 million SAR in microbiology over the 6-month period.


CONCLUSION: Minimum retest intervals using computer-based rules are effective in supporting strategies to manage demand.


LIMITATIONS: This approach may not be applicable to all laboratory tests; however, the success of this pilot study would encourage more widespread use of this approach.




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