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Demand management by electronic gatekeeping of test requests does not influence requesting behaviour or save costs dramatically
- Source :
- Annals of Clinical Biochemistry: International Journal of Laboratory Medicine. 55:244-253
- Publication Year :
- 2017
- Publisher :
- SAGE Publications, 2017.
-
Abstract
- Background Healthcare budgets face constraints, and laboratories have developed strategies to adapt to the concomitant increase in workload. Some of the tests (7.4%) may be attributed to unnecessary repeat testing. Electronic gatekeeping has been implemented at selected laboratories in South Africa to limit unnecessary repeat testing. We performed a study of chemistry tests subjected to electronic gatekeeping to determine its effectiveness as a sustainable demand management tool. Methods A 22-month retrospective study of chemistry test requests at a Pretoria hospital was performed. Tests violating electronic gatekeeping rules were rejected upon registration before analysis, and cost-savings were estimated from electronic gatekeeping-held tests. The impact of electronic gatekeeping on the test requesting pattern of clinicians was derived from the percentage cost of electronic gatekeeping-held tests. Results The total savings generated from electronic gatekeeping test rejections amounted to $84,380. Greatest savings were generated from high-cost tests: glycated haemoglobin ($14,139), urea ($8661) and thyroid-stimulating hormone ($7514). The average number of electronic gatekeeping-held tests as a percentage of their total requested number over 22 months was 3.18%. Discussion The savings from electronic gatekeeping-held tests were not as dramatic as anticipated, but were modest and may have some impact in a cost-constrained setting. Electronic gatekeeping was concluded not to have a substantial effect on the clinician test requesting pattern, demonstrated by the largely unchanged monthly percentage of electronic gatekeeping-held tests. As a solitary demand management strategy, electronic gatekeeping does not appear to be as effective as anticipated or as demonstrated in other studies.
- Subjects :
- Demand management
030213 general clinical medicine
Repeat testing
Clinical Biochemistry
Unnecessary Procedures
Medical Order Entry Systems
South Africa
03 medical and health sciences
0302 clinical medicine
Cost Savings
Health care
Humans
Medicine
Operations management
Glycated haemoglobin
Retrospective Studies
Gatekeeping
Clinical Laboratory Techniques
business.industry
Workload
General Medicine
Cost savings
Test (assessment)
030220 oncology & carcinogenesis
business
Subjects
Details
- ISSN :
- 17581001 and 00045632
- Volume :
- 55
- Database :
- OpenAIRE
- Journal :
- Annals of Clinical Biochemistry: International Journal of Laboratory Medicine
- Accession number :
- edsair.doi.dedup.....585cc1f9218d7c7356566a034ee73752