Lab utilization: Striking the balance between overuse and underuse

In today’s world of healthcare, laboratory utilization plays a crucial role in how patients are diagnosed and treated.¹ However, striking the right balance between performing too many and too few tests can be difficult and result in various consequences.^2-4

So, how can lab leaders ensure they are performing the right test for the right patient at the right time, optimizing not only the delivery of patient care but also the allocation of healthcare resources?

In order to answer this important question, we start the discussion and, explore the consequences of both the overutilization and underutilization of lab tests.

While laboratory tests are an indispensable tool for diagnosing and monitoring clinical conditions, their overuse can lead to a wide array of negative consequences, impacting healthcare systems and the delivery of patient care.^2,5 This has become an increasing issue in recent times, with research estimating that up to 56% of lab-based testing is wasteful due to not advancing patient care.⁵

Without being effectively managed, the overutilization of laboratory tests can lead to: 

• Increased healthcare costs — ordering unnecessary additional tests naturally results in a direct cost for the laboratory.⁶ Overtesting can also create an added need for further follow-up tests and procedures which, again, contributes to the overall financial burden.¹ Over time, these costs can become significant, putting a strain on resources that could be better allocated to other areas of patient care and clinical processes.

• Potential patient harm—performing excessive numbers of tests can pose a direct risk to patient health, resulting in additional anxiety and stress. It can also be associated with patient discomfort, disruption in sleeping patterns, and—in cases of repetitive routine blood testing—potentially lead to issues like hospital-acquired anemia.^2,5,6

While the overutilization of lab tests is an issue in itself, the inverse has also become a growing concern.^3,7 In fact, lab tests are estimated to be more underutilized than overutilized, with research indicating that mean rates of inappropriate underutilization may be as high as 44.8%.³ This can lead to various issues, including: 

• Missed diagnoses — during a review of a number of closed malpractice claims, underutilization was identified as a major contributor in up to 55% of ambulatory cases and up to 58% of emergency department cases.⁷ This can increase the likelihood of misdiagnoses, leading to conditions being left untreated and causing unnecessary harm to patients.⁴

• Delayed treatments — the increased risk of missed diagnoses can result in delays in patients being put on the correct treatment plans.² This, in turn, can lead to patients not receiving the actual treatment they need, which can be especially problematic when treating acute or chronic conditions, where timely intervention is crucial for achieving higher success rates.² 

Striking the right balance between the over and underutilization of lab tests is imperative to not only optimize patient care but also improve the operational efficiency of clinical laboratory environments.⁸ So how exactly can this be achieved moving forward?

Having continuous education and training opportunities available for lab personnel is crucial to ensuring correct lab test utilization. This helps lab leaders keep up to date with the latest guidelines and best practices, enabling them to educate physicians and clinicians on which tests to order at the right time. 

At the same time, lab personnel must be appropriately trained to make more informed decisions over whether a test should — or shouldn’t — be ordered.⁹ For example, in cases where there is an extremely strong likelihood that a certain diagnosis is present, training can help discourage any unnecessary testing, as the outcome will be already expected.⁹

On the flip side, training can also help emphasize the importance of avoiding tests in situations where the probability of identifying a diagnosis is very low, helping prevent the need for any unnecessary confusion or additional tests.⁹

Lab utilization management programs are structured approaches that can be used to help manage and monitor the use of laboratory tests.¹⁰ These programs often involve the creation of task forces or committees that review test ordering practices, develop guidelines, and implement policies to optimize test utilization.¹⁰

Using these programs can support the integration of decision-support tools, which can help lab personnel make research-backed decisions over which lab tests to order and ensure laboratory resources are used appropriately.¹⁰

Providing a summary of clinical performance over a specified period has long been used as a way to reinforce quality improvement interventions in medical practice.¹¹ As such, conducting regular audits into test ordering patterns may help to identify trends, outliers, and areas where test ordering may not align with best practices. This can then provide tangible feedback which, when discussed via the right mechanisms—such as peer comparisons, benchmark reports, and individual performance reviews—can help inform and adjust clinical practices.¹¹

Having this continuous loop of auditing and feedback can also help ensure that test utilization remains appropriate, aligned with clinical needs, and in the minds of lab personnel while they perform their duties.

Approximately 70% of clinical decisions are made based on lab test results, which highlights the importance of their contribution towards patient care, accurate diagnoses, and treatment planning.⁸ However, this reliance can also lead to additional strains being put on clinical laboratories, especially in terms of turning tests around quickly while maintaining the highest levels of accuracy. 

Fortunately, the technological advances over recent years, the rise of artificial intelligence (AI), and the ongoing use of electronic medical records can help reduce the level of this strain by assisting with the management of lab utilization practices.^8,12 

Deep learning-based automated systems have already been shown to accurately and efficiently identify which lab tests should be ordered, for example, helping to reduce under and overutilization problems.⁸

However, these systems can also support providers through their ability to analyze multiple data inputs, including patient symptoms, medical records, and current clinical guidelines.¹³ By amalgamating this information, AI-based software can now make tailored recommendations over which lab tests to use on patients to help avoid any unnecessary testing or expenditure.¹³ This, in turn, can not only help streamline the diagnostic process and overall workflow but also free up more time for staff to focus on other lab-based duties.⁸

Putting the correct amount of time and effort into optimizing strong lab utilization management strategies is an important way to improve patient health and reduce waste in an era of increasing financial pressures. 

By focusing on education, creating a structured management program, performing regular audits, and integrating advanced AI-based technologies, lab leaders can not only deliver optimal lab utilization but also maximize the efficiency of their laboratory processes.