David Brown commented:
Many repeats are
due to patient movement , between specialities
(haven't the time to look for the previous ones), use
of "holding" wards (where "admission profiles" are
requested and the patient moved to another ward before
the results are available), transfer of patients from
a satellite hospital to the acute DGH. and very often
patients are moved to a ward before casualty has
"received the results".
This seems likely to be true, or at least in accord with experience. But it
also has the advantage of being testable and potentially falsifiable; rare
to apply scientific method to a management issue!
If over-testing ("I know that half the money I spend on advertising is
wasted, the problem is that I don't know which half". Henry Ford) is caused
by patient transfers or lack of access to the results of a recent request
for the same tests, then the recent substantial improvements in turn-around
times and the increasing immediate availability of verified results on ward
terminals should have reduced this problem. Have they? Probably not.
Certainly these developments may have stopped the over-testing problem
getting worse as more patients are pushed through existing beds, and it
would be necessary to compare hospitals/services where these innovations
have occurred to varying degrees and at different times to test that
hypothesis.
An alternative explanation may be found in economics. In general, tests are
free to the requestor and they are often profitable (either financially or
in ego-trip terms) to the provider. Demand and supply, and price, do not
have their usual relationships. It is interesting to note that where tests
do carry a cost (as mentioned for microbiology in Carlisle) the demand is
rising at a lower rate. Health economists need to address these issues.
Our task as clinical biochemists or other laboratory-based professionals
(should we choose to accept it) is to find a way to distinguish in real
time between useful tests and non-useful ones. Because we cannot
distinguish them 100%, there will be trade-offs and some retrospectively
wrong decisions. But health administrators are increasingly aware that
laboratory testing takes a significant part of the health budget and they
are asking what they get for it, and whether they can get the same results
for less. As they should.
John Whitfield
Clinical Biochemistry
Royal Prince Alfred Hospital
Sydney, Australia
Phone (+61) 2 9515 5246
Fax (+61) 2 9515 7931
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