Strategies to promote rational clinical chemistry test utilization

Objective: To critically review the elements of laboratory services that result in inappropriate ordering of clinical chemistry tests and the efficacy of corrective interventions. Methods and Results: In our experience, inappropriate use of laboratory services derives from multiple factors, including the use of multitest profiles, organ- or disease-specific test panels, indiscriminate ordering, standing orders, excessive reporting delays, poor audit trails of test requests, rigid group test ordering, failure to eliminate obsolete tests, and some features of computer software design. Educational strategies can be effective in modifying test-ordering patterns, provided there is sustained feedback to physicians. Careful design of requisitions and the use of disease-specific algorithms have also proven effective. Conclusion: Limited resources must be directed to where they are most effective by optimizing laboratory work-flow from test ordering to reporting, to avoid practices that promote inappropriate laboratory use.