STRATEGIES TO PROMOTE RATIONAL CLINICAL-CHEMISTRY TEST UTILIZATION

Objective: To critically review the elements of laboratory services th at result in inappropriate ordering of clinical chemistry tests and th e efficacy of corrective interventions. Methods and Results: In our ex perience, inappropriate use of laboratory services derives from multip le factors, including the use of multitest profiles, organ- or disease -specific test panels, indiscriminate ordering, standing orders, exces sive 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 feedb ack to physicians. Careful design of requisitions and the use of disea se-specific algorithms have also proven effective. Conclusion: Limited resources must be directed to where they are most effective by optimi zing laboratory work-flow from test ordering to reporting, to avoid pr actices that promote inappropriate laboratory use.