A Learning Experience; Pathology Resident Triaging of Laboratory Tests.
Eva Drinka, Omar Habeeb, Kathy McKenna, Mary Cashin, Paul Schreckenberger, Eva Wojcik, Stephen Kahn. LUMC, Maywood, IL
Background: Many methods are used in the clinical training of pathology residents, the budgetary control of health care, and the improvement of laboratory test utilization. At Loyola University Medical Center, the practice of having pathology residents triage selected externally referred laboratory tests was implemented in an effort to train residents in laboratory management, enhance cost-effective test ordering, and improve laboratory utilization.
Design: Physician orders for externally referred tests with charges greater than $500 per patient are triaged every morning by an assigned resident. In addition, other selected tests (CSF viral PCR tests, such as HSV) are triaged by residents. For each referral test triaged the resident reviews the patient chart, clarifies the clinical indications of the ordered test, consults with a relevant pathology faculty member if necessary, and then decides whether to approve the test referral or discuss the order further with the ordering physician. For the purposes of this study, data on all tests triaged by residents from 7/1/2008 to 6/30/2010 (24 months) were compiled and evaluated. Collected data include the name of each test ordered by the clinician, test cost, and if the test was subsequently cancelled as a result of review of the medical record.
Results: A total of 1714 send out tests meeting triage criteria were investigated by residents over a 24 month period. A total of 397 tests were cancelled after consultation with ordering physician (23% of all tests triaged). The average charge of tests meeting triage criteria was $704, while the average charge of the tests cancelled was $493. The total cost of triaged tests over the 24 month period came to $1,199,521, and the total amount saved by triaging and cancelling unnecessary send out tests came to $193,307. This represents a total savings of 16%. The most frequently cancelled test was also the most frequently ordered test, HSV PCR ($171).
Conclusions: Triaging selected referred laboratory tests is effective in reducing testing and associated costs. It ensures that testing performed is medically appropriate. Involving residents in this process provides significant educational benefits. The resident pathologist gains valuable insight and experience as a laboratory director in training. This includes the use of evidence based medicine, and the implementation of clinical guidelines in the proper ordering of tests. The use of our resident based triaging system has proven effective in helping to reduce overall testing costs, can be a valuable learning opportunity for residents, and is a catalyst for open communication between the clinician and pathologist.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 75, Monday Morning