Analysis of test requisitions and optimum utilization of routine laboratory investigation in a tertiary care teaching hospital

Author : Rakhi Negi, Vinod Raghav, Mukul Bajpai, Pratap Shankar, Rakesh Kumar Dixit

Background: Overutilization of investigations, leads not only to excessive burden on the laboratory but also gives rise to a multitude of problems in patient management. Practice of evidence based laboratory medicine and awareness of cost effectiveness of tests amongst prescribing clinicians is hence of paramount importance to address this problem. Aim: The aim of this study is to analyse the prescribed requisitions for common hematological and biochemical tests and determine the prevalence of the “inappropriate” and “avoidable” tests. Materials and Methods: We conducted a retrospective cross- sectional study on hospital records of 150 male patients admitted to acute medical and surgical wards from 01 Dec 2015 to 29 Feb 2016 at a tertiary care teaching hospital located in North India. The tests requisitions for routine biochemical and hematological investigations during period of admission were analysed and categorized into three categories by a panel of three doctors: appropriate, inappropriate and avoidable. Results: In our study we analysed 10236 requisitions of common biochemical and hematological tests ordered for 150 admitted male patients and found that only 50.4% tests were clinically “appropriate”. 22.4% of the total tests performed were “inappropriate” and hence were wasteful. 27.2% of tests were categorized as “avoidable”. Conclusion: This study provides a detailed insight into the investigation requisition pattern for most common hematological and biochemical investigations which form a major part of workload in a clinical laboratory. The study shows that a considerable number of investigations are inappropriate and do not contribute to patient management in any manner. These tests are a drain on the resources and hence must be eliminated by formulation of strict guidelines and protocols. On the other hands there are some avoidable test orders which arise from inability of the clinicians to prescribe tests in accordance to pretest probabilities and evidence based practice. These avoidable tests can be reduced by interactive education of the clinicians.

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