Preface

Table of contents

1 Introduction: clinical laboratory contribution to patient safety

References

2 Inappropriateness in laboratory test requesting in the literature

2.1 Laboratory process-test request

2.2 Definition of inappropriate requests

2.3 Causes of inappropriate test requests

2.3.1 Laboratory

2.3.2 Requesting physician

2.3.3 The patient

2.3.4 Factors inherent in the system

2.4 Reducing inefficiency in the laboratory diagnostic process

2.5 Tools described in the literature for the management of the demand for laboratory tests: before, during, and after the request

2.5.1 Before

2.5.2 During the request

2.5.3 After the request

2.6 The future: where we are going

References

3 Causes and negative effects of inappropriateness in laboratory test requesting

3.1 Introduction

3.2 Causes of inappropriateness in laboratory test requesting

3.2.1 Clinician’s unawareness about the test

3.2.2 Communication between clinical and laboratory departments

3.2.3 Others

3.3 Negative effects of inappropriateness in laboratory test requesting

References

4 Strategies to correct inappropriateness in laboratory test requesting

4.1 Introduction

4.2 Types of strategy to correct inappropriateness in laboratory tests

4.2.1 Strategies based on education, audit, and feedback

4.2.2 Rules and agreements aimed at vetting test requests

4.2.3 Re-design of the request formularies

4.2.4 Computer physician order entry

4.3 Strategies to correct inappropriateness in laboratory test requesting and phase of intervention

4.3.1 Pre-requesting phase interventions

4.3.2 During requesting interventions

4.3.3 Post-requesting interventions

4.4 Laboratory medicine

4.5 Epilogue

References

5 Practical pathway to design, establish, and monitor over time test requesting appropriateness strategies: indicators to detect the inappropriateness and to monitor after interventions

5.1 Introduction

5.2 The plan-do-check-act cycle as a basis in the design of strategies to correct inappropriateness in laboratory test requesting

5.3 Indicators that intervene in strategies to correct inappropriateness in laboratory test requesting

5.3.1 Indicators in clinical laboratory: general considerations

5.3.2 Indicators to detect test inappropriateness and to monitor after the establishment of the different interventions

5.4 A step-by-step description of strategies to correct inappropriateness in laboratory test requesting

5.4.1 Identify laboratory test inappropriateness

5.4.2 Selection of the test and target population

5.4.3 Generation of the idea

5.4.4 Pre-design of the strategy

5.4.5 Strategy final design

5.4.6 Strategy establishment

5.4.7 Monitoring through process indicators

5.4.8 Evaluation through outcome indicators

5.4.9 Final decision whether to continue or stop the strategy

References

6 Potential of computer physician order entry (CPOE) to improve patient safety related to laboratory test requesting

6.1 What is a computer physician order entry (CPOE) system?

6.2 CPOE interventions

6.3 Design strategies

6.3.1 Re-design of the request formularies

6.3.2 Use of clinical (or “disease-specific”) profiles/panels

6.3.3 Customized formularies

6.3.4 Display costs/fees

6.3.5 Search functions

6.3.6 Research/clinical trial formularies

6.4 Clinical decision support rules

6.4.1 Specialty/staff-grade limitations

6.4.2 Minimum retest intervals

6.4.3 Asking for additional information: questions

6.4.4 Suggestions/corrections

6.5 CPOE advantages in pre-analytical phase

6.6 Conclusions

References