Policy change to improve pathology turnaround time and reduce costs - possible to do both?

Dimeski, Goce, Silvester, Breeann, Ungerer, Jacobus, Johnson, Leslie and Martin, Jennifer H. (2013) Policy change to improve pathology turnaround time and reduce costs - possible to do both?. Biochemia Medica, 23 3: 296-302. doi:10.11613/BM.2013.035

Author Dimeski, Goce
Silvester, Breeann
Ungerer, Jacobus
Johnson, Leslie
Martin, Jennifer H.
Title Policy change to improve pathology turnaround time and reduce costs - possible to do both?
Journal name Biochemia Medica   Check publisher's open access policy
ISSN 1330-0962
Publication date 2013-01
Sub-type Article (original research)
DOI 10.11613/BM.2013.035
Open Access Status DOI
Volume 23
Issue 3
Start page 296
End page 302
Total pages 7
Place of publication Zagreb, Croatia
Publisher Medicinska Naklada
Collection year 2014
Language eng
Formatted abstract
Background: Overcrowding and prolonged length of stay in emergency departments (ED) are increasing problems in hospitals. Rapid availability of all laboratory results has an impact on clinical decision-making, admissions or discharge decisions and resource utilisation. Increasing number of our urinary drugs of abuse (DOA) screens had a turnaround time (TAT) of up to 33 days after the discharge of the patient.

Materials and methods: Following an audit and a consultation period with clinicians using the service, a policy change was implemented to reduce the use of gas chromatography mass spectroscopy (GCMS): all requests would have a standard immunoassay (IA) test panel undertaken unless specifically they requested GCMS (including medico-legal) analysis.

Results: Almost all of the clinicians interviewed had no understanding of the DOA screening or the difference in the information generated between a confirmatory GCMS urine toxicology screen and IA DOA panel. It appeared none of the patients surveyed in the audit would have had a different clinical decision made if a GCMS had not been undertaken. Post change audit showed only 4.3% of drug requests for IA also received a confirmatory GCMS testing. The estimated saving post change implementation was $127,000 (AU $) in test costs alone over a two year period. The TAT of GCMS results was reduced to 3-4 days.

Conclusion: A laboratory-led behavioural change in test requesting is possible and sustainable provided the reason is clinically sound and accompanied by consultation and availability of advice by phone when requested on test requesting or interpretation.
Keyword Immunoassay
Gas-chromatography mass spectrometry
Pathology requests
Drugs of abuse
Urine testing
Behavioural change
Turnaround time
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
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