Impact of Laboratory Test Use Strategies in a Turkish Hospital.

OBJECTIVES: Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs. METHODS: A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months. RESULTS: Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars. CONCLUSION: Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.

A (99m)Tc-DTPA ventilation study in monitoring the effect of budesonide in asthmatic children.

This study was performed to identify the role of technetium-99m diethylene triamine penta-acetic acid ((99m)Tc DTPA) aerosol ventilation scintigraphy in the initial assessment and follow-up of children with bronchial asthma. In this prospective study conducted over a period of 2 years, 45 children (35M, 10F) aged 6-12 yrs (8.4 ± 2.2 years) with newly diagnosed moderate persistent bronchial asthma were included. Peak expiratory low (PEF) was measured and asthma symptom scores were calculated. Ventilation scintigraphy was performed after inhalation of (99m)Tc DTPA aerosol. The studies were repeated after 4 weeks of treatment with 400mcg budesonide daily. Pre and post treatment ventilation patterns were described, semiquantified and compared. Three patterns of ventilation were observed: a) homogenous (19/45), b) central airway deposition (21/45) and c) inhomogenous (5/45) with corresponding central: peripheral counts per pixel ratio of 1.265, 1.865 and 1.324 respectively. Ventilation pattern showed improvement (more counts in the periphery) in 22/45 children. Sixteen of 45 patients showed homogenous ventilation in both baseline and follow-up studies; abnormal central deposition was seen in both studies in 2/45. Five out of 45 children (3 with initial homogenous and 2 with initial inhomogenous patterns showed worsening on the follow-up scan after 4 weeks. In conclusion, semi-quantitave ventilation scintigraphy with (99m)Tc DTPA aerosol in asthmatic children repeated after 4 weeks treatment with budesonide showed better correlation with clinical symptom scores than PEF rates in monitoring response to treatment.