Optimization of Diagnostic Laboratory Testing

Author(s): Professor. Gurmukh Singh and Professor Emeritus. Fred V. Plapp

Objectives

To assess the degree of overuse of laboratory testing, risks of over testing, causes of over testing and evaluation of approaches to optimize laboratory testing.

Methods

Personal observations based on more 90-year experience, and review of literature were used to determine the causes of over-testing and proposed methods for improving the optimization of testing. Opinions from personal experiences and issues about the future are expressed.

Results

Laboratory tests drive about 70% of clinical decisions, however, there is marked overuse of testing that adds an appreciable amount to the cost of healthcare, without improving the quality of healthcare. The cost of laboratory testing in the US exceeds the gross domestic product of more than 67% of countries. Despite having the highest cost of healthcare per capita, the US ranks at number 18 in terms of healthcare quality. Over-testing also poses safety risks to patients in the form of misdiagnoses, overtreatment, added cost to patients, society, and phlebotomy-induced anemia.

Conclusion

Laboratory testing costs can be curtailed without affecting the quality of healthcare. Issues of testing without specimen collection need to be addressed. National organizations are implored to include standards for optimal laboratory use in the accreditation of laboratories and hospitals.

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