P-010 Cross-disciplinary workflows Poster

From overuse to optimization: a hospital-wide laboratory test panel intervention

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Authors

T.L. Van Osch presenting

Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands.

#0
D.J. De Cuyper

Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, the Netherlands.

#1
A.H. Brunsveld-Reinders

Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, the Netherlands.

#2
A.C. Vossen

Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.

#3
F.G. Ropers

Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.

#4
M. De Geus-Bosma

Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, the Netherlands

#5

Abstract

Over recent years, an unrestrained increase in laboratory test panels occurred within Leiden University Medical Center, resulting in an excessive number of test panels (3970) in the electronic health record (EHR). The lack of centralized governance, systematic review, and a clear distinction between lab tests for clinical and research purposes led to a fragmented and suboptimal ordering structure. Within clinical chemistry, overtesting was estimated at 10–20%, driven by duplicate testing, excessive repeat orders, and outdated panels containing non-indicated assays. Additionally, undertesting occurs. The implementation of a new EHR provided an opportunity for hospital-wide optimization.

A multidisciplinary team developed a framework, including a decision tree, to support clinical departments in critically reviewing and redesigning their test panels. The framework addressed clinical indications, repeat intervals, added value of individual tests, distinction between care and research, and functionalities such as add-on and reflex testing. All departments reviewed their test panels, after which laboratory specialists evaluated and refined proposed revisions.

This project reduced the number of test panels by 29.3%, improved standardization, and reduced administrative burden. Panels became more up to date, specific, and better aligned with guidelines and care pathways. Significant reductions were observed in, i.e., BSE, amylase, LDH, and uric acid testing. Further quantitative evaluation of the resulting reduction in over- and undertesting is ongoing.

Policy-driven restructuring, expert review, and reflex testing improved the quality and efficiency of laboratory diagnostics, contributing to better resource utilization. Future projects will continue to optimize test panel utilization by aligning ordering practices with evidence-based clinical needs.

The project also revealed EHR limitations that restricted further optimization. Most notably, the implementation of clinically driven modular test panel building blocks (e.g., for kidney function, anemia, or other diagnostic domains) proved unfeasible, as each building block generated a separate lab order that could not be consolidated. In addition, implementation was complicated by EHR-related authorization constraints associated with different roles within the care pathway (e.g., physicians, nurses, and administrative staff) and limitations in the transparent and intuitive display of laboratory test panels within the EHR.