Overutilization in laboratory medicine: tackling the problem with quality improvement science

Abstract

Overutilization of tests and treatments is a widespread problem in contemporary heath care, and laboratory medicine is no exception. It is estimated that 10–70% of laboratory tests may be unnecessary, with estimates in the literature varying depending on the situation and the laboratory test. Inappropriate use of laboratory tests can lead to further unnecessary testing, adverse events, inaccurate diagnoses, and inappropriate treatments. Altogether, this increases the risk of harm to a patient, which can be physical, psychological, or financial in nature. Overutilization in healthcare is driven by complex factors including care delivery models, litigious practice environments, and medical and patient culture. Quality improvement (QI) methods can help to tackle overutilization. In this review, we outline the global healthcare problem of laboratory overutilization, particularly in the developed world, and describe how an understanding of and application of quality improvement principles can help to address this challenge.

Keywords:

• Stewardship
• test utilization
• overutilization
• quality improvement
• laboratory medicine

Acknowledgements

The authors would like to thank the following individuals for their critical involvement in at least one of the projects discussed in this manuscript: Drake Yip, Shafqat Tahir, Maverick Chan, Michelle Sholzberg, Patrick O’Brien, Thomas Bodley, Orla Levi, Jan Friedrich, Orla Smith, Curtis Handford, Seema Bhandarkar, Jeff Mosko. We thank the following individuals for their leadership: Thomas Parker, Doug Sinclair, Anne Trafford, Dawn-Marie King, and Victor Tron.

Disclosure statement

The authors report no relevant conflicts of interest.