Utilization management has been a traditional approach to control costs in clinical laboratory services for several decades. Following utilization management, best practices results in the highest quality care at the lowest cost, supports Lean and Six Sigma initiatives, and saves significant time and money. In fact, appropriate utilization reduces patient risk and empowers organizations to provide the highest quality of care. While it is good to have an understanding of utilization management, IFCC Committee on Clinical Laboratory Management has recently conducted an international survey to investigate what does this mean for the laboratory leaders and examined the state of medical laboratory test utilization management and relevant practices which are country-specific from a laboratory leader perspective. The findings of this survey revealed that the recognition of test utilization management, current practices, and maturation of those programs are significantly diverse among countries. It is relatively well established in most developed nations. However, the findings have confirmed that the need to develop a roadmap and to construct essential strategies for managing laboratory test utilization is a common interest. With this regard, it is of importance to select the right management tool to implement an optimal laboratory test utilization.

Utilization management has been a traditional approach to control costs in clinical laboratory services for several decades. Following utilization management, best practices results in the highest quality care at the lowest cost, supports Lean and Six Sigma initiatives, and saves significant time and money. In fact, appropriate utilization reduces patient risk and empowers organizations to provide the highest quality of care. While it is good to have an understanding of utilization management, IFCC Committee on Clinical Laboratory Management has recently conducted an international survey to investigate what does this mean for the laboratory leaders and examined the state of medical laboratory test utilization management and relevant practices which are country-specific from a laboratory leader perspective. The findings of this survey revealed that the recognition of test utilization management, current practices, and maturation of those programs are significantly diverse among countries. It is relatively well established in most developed nations. However, the findings have confirmed that the need to develop a roadmap and to construct essential strategies for managing laboratory test utilization is a common interest. With this regard, it is of importance to select the right management tool to implement an optimal laboratory test utilization.

Utilization management has been a traditional approach to control costs in clinical laboratory services for several decades. Following utilization management, best practices results in the highest quality care at the lowest cost, supports Lean and Six Sigma initiatives, and saves significant time and money. In fact, appropriate utilization reduces patient risk and empowers organizations to provide the highest quality of care. While it is good to have an understanding of utilization management, IFCC Committee on Clinical Laboratory Management has recently conducted an international survey to investigate what does this mean for the laboratory leaders and examined the state of medical laboratory test utilization management and relevant practices which are country-specific from a laboratory leader perspective. The findings of this survey revealed that the recognition of test utilization management, current practices, and maturation of those programs are significantly diverse among countries. It is relatively well established in most developed nations. However, the findings have confirmed that the need to develop a roadmap and to construct essential strategies for managing laboratory test utilization is a common interest. With this regard, it is of importance to select the right management tool to implement an optimal laboratory test utilization.

More than half of the request protocols sent to clinical laboratories are unsuitable for making the correct diagnosis – be it because unnecessary tests are requested (overutilization) or important tests are missing (underutilization). Diagnostic pathways, based on standardized decision trees, are a solution to this serious issue. They represent “smart test profiles” (as opposed to rigid profiles), which are worked up just to the point, where a diagnostic decision can be made. Clinical, economic, and statistical benefits of diagnostic pathways will be discussed. A second issue of laboratory test utilization is the correct interpretation of the analytical results. In view of the current flood of laboratory values, the recipients are hardly able to recognize important trends and test constellations at a glance. There is also the problem of different methods and units, which makes it difficult to compare laboratory values from different sources – especially if they are stored in electronic medical records for life. The proposed solution to this problem is to relate the absolute values to the respective reference interval and to convert the so-called zlog values obtained in this way into standardized colors. The advantages of this procedure for the intuitive interpretation of laboratory values and the increase in patient safety are discussed.

More than half of the request protocols sent to clinical laboratories are unsuitable for making the correct diagnosis – be it because unnecessary tests are requested (overutilization) or important tests are missing (underutilization). Diagnostic pathways, based on standardized decision trees, are a solution to this serious issue. They represent “smart test profiles” (as opposed to rigid profiles), which are worked up just to the point, where a diagnostic decision can be made. Clinical, economic, and statistical benefits of diagnostic pathways will be discussed. A second issue of laboratory test utilization is the correct interpretation of the analytical results. In view of the current flood of laboratory values, the recipients are hardly able to recognize important trends and test constellations at a glance. There is also the problem of different methods and units, which makes it difficult to compare laboratory values from different sources – especially if they are stored in electronic medical records for life. The proposed solution to this problem is to relate the absolute values to the respective reference interval and to convert the so-called zlog values obtained in this way into standardized colors. The advantages of this procedure for the intuitive interpretation of laboratory values and the increase in patient safety are discussed.

More than half of the request protocols sent to clinical laboratories are unsuitable for making the correct diagnosis – be it because unnecessary tests are requested (overutilization) or important tests are missing (underutilization). Diagnostic pathways, based on standardized decision trees, are a solution to this serious issue. They represent “smart test profiles” (as opposed to rigid profiles), which are worked up just to the point, where a diagnostic decision can be made. Clinical, economic, and statistical benefits of diagnostic pathways will be discussed. A second issue of laboratory test utilization is the correct interpretation of the analytical results. In view of the current flood of laboratory values, the recipients are hardly able to recognize important trends and test constellations at a glance. There is also the problem of different methods and units, which makes it difficult to compare laboratory values from different sources – especially if they are stored in electronic medical records for life. The proposed solution to this problem is to relate the absolute values to the respective reference interval and to convert the so-called zlog values obtained in this way into standardized colors. The advantages of this procedure for the intuitive interpretation of laboratory values and the increase in patient safety are discussed.

Moderate impaired renal function is asymptomatic. However, medical procedures such as drug therapy with nephrotoxic drugs pose a substantial risk to these patients. Therefore, patients with impaired renal function are at high risk for morbidity and mortality and can be associated with high costs, longer lengths of stay, or significant side effects of drug therapy. Correct renal function testing in the hospital is pivotal to detect chronic kidney disease (CKD), to avoid further damage to the kidneys, and to obtain an optimized pharmacological therapy. Current protocols for renal function testing (in particular those relying on creatinine alone) have been known to wrongly classify certain patients, leading to inappropriate drug dosing and poor outcomes. We hypothesized that optimization of non-invasive renal function testing will improve pharmacological treatment and avoid further renal damage without consuming significant additional resources. We addressed discrepancies noted between patients who had received both creatinine- and cystatin c-based eGFRs employing LIS/middleware capabilities and the cooperation of the clinical care team (Oncology, Nephrology, Pharmacy, Laboratory Medicine/Clinical Pathology). About a third of the inpatients at Marienhospital have severely impaired renal function. Parallel reporting of creatinine- and of cystatin C-based eGFRs mitigates wrongful CKD classification and improves accuracy of CKD staging and drug dosing in 25% of the patients. A cost-benefit analysis of this approach was performed in 606 patients treated with certain chemotherapeutic drugs: When parallel testing using cystatin C in addition to creatinine was performed, the eGFR-tailored dosing allowed a cost avoidance of about $105,000 euros by a reduction in chemotherapy drugs. In addition to these quantifiable savings comes the avoidance of unwanted side effects which benefits both the patients and the hospital resources.

Moderate impaired renal function is asymptomatic. However, medical procedures such as drug therapy with nephrotoxic drugs pose a substantial risk to these patients. Therefore, patients with impaired renal function are at high risk for morbidity and mortality and can be associated with high costs, longer lengths of stay, or significant side effects of drug therapy. Correct renal function testing in the hospital is pivotal to detect chronic kidney disease (CKD), to avoid further damage to the kidneys, and to obtain an optimized pharmacological therapy. Current protocols for renal function testing (in particular those relying on creatinine alone) have been known to wrongly classify certain patients, leading to inappropriate drug dosing and poor outcomes. We hypothesized that optimization of non-invasive renal function testing will improve pharmacological treatment and avoid further renal damage without consuming significant additional resources. We addressed discrepancies noted between patients who had received both creatinine- and cystatin c-based eGFRs employing LIS/middleware capabilities and the cooperation of the clinical care team (Oncology, Nephrology, Pharmacy, Laboratory Medicine/Clinical Pathology). About a third of the inpatients at Marienhospital have severely impaired renal function. Parallel reporting of creatinine- and of cystatin C-based eGFRs mitigates wrongful CKD classification and improves accuracy of CKD staging and drug dosing in 25% of the patients. A cost-benefit analysis of this approach was performed in 606 patients treated with certain chemotherapeutic drugs: When parallel testing using cystatin C in addition to creatinine was performed, the eGFR-tailored dosing allowed a cost avoidance of about $105,000 euros by a reduction in chemotherapy drugs. In addition to these quantifiable savings comes the avoidance of unwanted side effects which benefits both the patients and the hospital resources.

Moderate impaired renal function is asymptomatic. However, medical procedures such as drug therapy with nephrotoxic drugs pose a substantial risk to these patients. Therefore, patients with impaired renal function are at high risk for morbidity and mortality and can be associated with high costs, longer lengths of stay, or significant side effects of drug therapy. Correct renal function testing in the hospital is pivotal to detect chronic kidney disease (CKD), to avoid further damage to the kidneys, and to obtain an optimized pharmacological therapy. Current protocols for renal function testing (in particular those relying on creatinine alone) have been known to wrongly classify certain patients, leading to inappropriate drug dosing and poor outcomes. We hypothesized that optimization of non-invasive renal function testing will improve pharmacological treatment and avoid further renal damage without consuming significant additional resources. We addressed discrepancies noted between patients who had received both creatinine- and cystatin c-based eGFRs employing LIS/middleware capabilities and the cooperation of the clinical care team (Oncology, Nephrology, Pharmacy, Laboratory Medicine/Clinical Pathology). About a third of the inpatients at Marienhospital have severely impaired renal function. Parallel reporting of creatinine- and of cystatin C-based eGFRs mitigates wrongful CKD classification and improves accuracy of CKD staging and drug dosing in 25% of the patients. A cost-benefit analysis of this approach was performed in 606 patients treated with certain chemotherapeutic drugs: When parallel testing using cystatin C in addition to creatinine was performed, the eGFR-tailored dosing allowed a cost avoidance of about $105,000 euros by a reduction in chemotherapy drugs. In addition to these quantifiable savings comes the avoidance of unwanted side effects which benefits both the patients and the hospital resources.