Is there too much laboratory testing?

There is evidence that the numbers of diagnostic tests performed in hospital laboratories could be reduced without affecting outcomes to patients, and with significant concommitant reduction in costs. The concentration of testing in centralised laboratories located in larger hospitals, and the use of automated techniques, together with an increase in the types of tests available, have contributed to the large increase in test requests. This trend has been apparent for many years. There has been little, if any, control of test requests. Moreover, the patterns of requests for laboratory tests differ between physicians, which suggests that some tests are unnecessary. The methods which have been used to modify clinical behaviour fall into six categories: education, feedback, participation, peer review, financial incentives and administrative changes. It is concluded that no single method is effective and a combination of methods may be necessary depending on the situation. Whatever methods are adopted, they must be sustained for introducing test request reductions in hospitals. It is shown that increasing use of desk top analysers in general practice and hospital wards will only have a small impact on the numbers of tests requested. The NHS Review, which incorporates costing procedures for diagnostic tests, may cause a reduction in hospital test requests once their costs are known. Determining costs will itself be an expensive and time consuming process, but an inevitable product of information technology investments (e.g. The Resource Management Initiative).