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CAP Today: “Powering down on excessive test use”

Curtis Hanson, M.D.

Curtis Hanson, M.D.

In the February issue of CAP TODAYCurtis Hanson, M.D.,  professor of laboratory medicine and pathology at Mayo Clinic, and James Stubbs, M.D., chair of the Division of Transfusion Medicine at Mayo Clinic, were interviewed for the article, “Powering down on excessive test use.” Focusing on optimal laboratory utilization, the article discusses a variety of methods to power utilization objectives.

According to Dr. Hanson, who leads the Mayo utilization effort, a variety of steps can be used to establish a utilization review process: develop medical criteria for sending out high-cost tests, avoid repeating tests unnecessarily, and set up a laboratory review process using algorithms and guidelines for selected tests.

“Labs don’t provide guidance on how to order the appropriate assays in various diseases. And if laboratories don’t have an appropriate review and ordering process in place, clinicians have no choice but to order excess testing,” said Dr. Hanson. “The job of laboratories is to move clinicians from asking, “Do you do this test?” to “Can you help me solve this clinical problem?”

Dr. Hanson also discussed utilization in terms of overall health care.

“I’m familiar with the argument that since lab tests only account for a few percent of overall health care costs, don’t be stressed about test utilization,” Dr. Hanson continues. “But I see labs being able to take a leadership role in driving down overall costs within a health system. We touch all clinicians by dealing with utilization in the laboratory. It sets a goal and puts processes in place that can then be used throughout the health care system.”

stubbs

James Stubbs, M.D.

While hematopathology was one of Mayo’s first utilization efforts, more recently it applied many of the same principles to optimizing use of blood products, with Dr. Stubbs leading the effort. Dr. Stubb and his team developed a program of blood management in cardiovascular surgery patients. The program utilized an algorithm based on coagulation tests routinely obtained in cardiopulmonary bypass (CPB) patients. When they applied the algorithm intraoperatively to half of a group of 92 cardiovascular surgery patients with abnormal bleeding after CPB, they found a statistically significant decrease in the amount of fresh frozen plasma and platelets transfused compared with usual practice. Patients in the algorithm group also had less bleeding in the ICU and a decrease in mediastinal exploration. In addition, an algorithm was developed for postoperative care.

According to Dr. Stubbs, “Use of the intraoperative and postoperative algorithms reduced red blood cell transfusions by 47 percent and transfusions of plasma, platelets, and cryoprecipitate by 57 percent. During that period the total cost of transfusions dropped by $2 million, for a calculated savings of $7.37 for every dollar invested in the project.”

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