IBMS Congress

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Inappropriate testing: can we change behaviour?

Demand Management

Education, Training & Management

Healthcare budgets worldwide are facing increasing pressure to reduce costs and improve efficiency, whilst maintaining quality. Indeed, this is the focus of the UK Department of Health (DH) QIPP (Quality, Innovation, Productivity and Prevention) agenda. Laboratory testing has not escaped this pressure, particularly since pathology investigations cost the NHS £2.5 billion per year.

Indeed, the Carter Review, the DH-commissioned review of pathology services in England, estimated that up to £500 million in savings could be made by improving pathology services, despite an average annual increase in workload of around 10% in some disciplines.

One area of increasing importance is managing demand for pathology tests and reducing inappropriate requesting, estimated by Carter at 25% of pathology tests. In this session, I propose to:

1. Discuss the drivers for demand management
2. Illustrate tools for identifying abnormal requesting patterns
3. Show how to estimate the prevalence of inappropriate requesting, recognising that demand management is not the same as demand control (‘…..may go up as well as down’).
4. Describe, with examples, ways by which inappropriate testing might be reduced, emphasising (a) the need to modify requesting behaviour rather than simply reject tests and (b) consideration of the whole patient pathway.

Demand management should be an integral part of our ongoing laboratory service development. Financial imperative or duty of care? Both.