Test Utilization: A Deeper Look

The test utilization seminar I attended at the AACC annual meeting (I talked about it here) presented fascinating information that I’m going to try and sum up for you.

Test utilization isn’t just about ordering the right test, making sure the order entry system is efficient, or even about the accuracy of the test. Sure, all those factors are important, but patients aren’t treated by laboratory data. They’re treated by doctors, and those doctors are human. Humans are irrational and make mistakes for all sorts of reasons like fear, cognitive limitations, and social complications. Medical decisions are incredibly complex and driven my mounds of data. This complexity contributes to medical errors.

I found this notion counter intuitive—one would think that more data would mean better decisions. However, a study conducted by the CIA on horse race prediction found that when analysts were given more data, the accuracy of their predictions didn’t improve. However, the analysts had more confidence in their predictions. What does this mean? Just because your doctor runs fifty tests doesn’t mean he’ll diagnose you accurately. It probably means, though, the doctor will be confident they are right.

Another tidbit from the seminar: diagnostic error is usually the convergence of several different factors that are organizational, cognitive, and technical in nature. Any laboratory professional who has dealt with major errors has seen this in action—an event investigation will usually reveal that anything that could go wrong did, and that’s why the event occurred. The authors of this particular study did note that technical/equipment problems contributed to only a small fraction of diagnostic errors. This speaks to the integrity, critical thinking, dedication to quality that laboratory professionals possess.

If you want to read more, here are a few of the studies mentioned during the talk:

Diagnostic Error in Internal Medicine http://archinte.jamanetwork.com/article.aspx?articleid=486642

CIA: Do You Really Need More Information? https://www.cia.gov/library/center-for-the-study-of-intelligence/csi-publications/books-and-monographs/psychology-of-intelligence-analysis/art8.html



Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Test Utilization Made Easy

Just kidding–this sort of thing isn’t easy. Right?

Not so fast. A few days ago I attended a session on test utilization management at the AACC meeting in Chicago. While the issue is quite complex–it’s not just a matter of right test/right patient/right time (which is tough enough already)–the speakers gave the audience a few relatively easy ways to improve test utilization.

  • Find and fix ordering errors
  • Identify tests with limited clinical use and eliminate them from your menu
  • Suggest a better test for the same disease/condition
  • Identify and correct deviations from established guidelines
  • Investigate odd patterns. (For example, if General Hospital generates 5% of your business but accounts for 70% of test X.)
  • Monitor year-to-year practice variations

As I said, this issue is quite complex, but implementing even a few of these changes could improve your lab’s bottom line.



Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.