![]() The sections on haematology and microbiology pay greater attention to specific clinical strategies for demand management. The various strategies that have been used to manage demand are described in the clinical biochemistry section. In this review, we discuss the role of demand management of requests made by clinicians in the fields of biochemistry, haematology, and microbiology. This will require paying attention to the product (identifying areas for demand management in consultation with clinicians), placement (bidirectional ward test ordering systems), price (clear cost/benefit analysis), and promotion (use of advertising material that appeals to both senior and junior medical colleagues). Marketing strategies have to be developed to “sell” the concept of demand management to clinicians (consumers). Thus, there is little incentive for clinicians to alter their current patterns for requesting laboratory tests. In the UK, neither the clinician nor the patient directly pays for the laboratory tests. 8Ī major obstacle to successful implementation is “consumer resistance”. A recent survey of clinicians has shown that only a very few consider or are aware of test characteristics such as the sensitivity and specificity of tests. In turn, this will probably lead to a greater understanding of the usefulness and limitations of the laboratory tests. Finally, greater recognition of the importance of multidisciplinary working and the development of care pathways is bringing about a closer working relationship between clinicians and laboratory staff. Second, with the current emphasis on evidence based medicine, there is greater willingness to examine the evidence concerning clinical usefulness for many of the currently performed tests. 7 The introduction of electronic patient records will further facilitate this process (Sunrise Clinical Manager iSOFT, Manchester, UK). Test ordering databases are currently available that incorporate decision support systems to prompt the clinician about the clinical need and the existence of previous or duplicate tests. Three recent developments in the NHS might now provide important opportunities to introduce, implement, and above all sustain rational laboratory testing.įirst, the increasing availability of bidirectional links between the laboratory and clinical areas is enabling clinicians to order tests and receive results using computers. Hopeless as it may seem, it may now be possible to manage demand for laboratory tests. A recent systematic analysis has shown that the effects of such strategies are frequently short lived owing to changes in junior clinical staff, lack of interest of senior clinicians, and the redundancy of the guidelines. Various strategies have been undertaken to manage demand. “Several studies have shown that between 25% and 40% of all tests sent to the laboratory are unnecessary” With all these barriers, it is not surprising that although attractive in concept demand management has failed to make appreciable inroads. Furthermore, recommendations of special interest groups, peer and commercial pressure, patient expectation, and more recently, fear of litigation have led to increased demand for laboratory tests. 6 These include uncertainty of likely diagnosis (associated with junior and inexperienced doctors) lack of understanding of the basis, sensitivity, and specificity of the tests and the desire for diagnostic completeness. So, what is it that makes it difficult to manage demand? Several reasons have been suggested. ![]() ![]() 3– 5Įven where such reductions have been achieved, it has been difficult to sustain them. Several studies have shown that between 25% and 40% of all tests sent to the laboratory are unnecessary, yet few laboratories in the UK have managed to reduce these unnecessary tests. 2 Although rationalisation of laboratories is important for efficient management of resources, it is unlikely that the resources in the NHS will ever be able to keep up unless a serious attempt is made to manage demand for pathology tests. ![]() ![]() 1 In response to this increase in laboratory tests, hospitals in the National Health Service (NHS) are being urged to rationalise the number of laboratories and to create fewer, more modern laboratories to benefit from economies of scale. A recent report of The National Pathology Alliance Benchmarking Review indicated that nearly all laboratories in the UK continue to witness a rise of 5% to 10% each year in requests for laboratory tests. ![]()
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