Development and Evaluation of a Laboratory Test Ordering System Based on Rational Laboratory Use and Personnel Participation at Nongmamong Hospital
Keywords:
Rational laboratory use, Clinical decision support system, Digital technology, Personnel participationAbstract
Inappropriate laboratory test utilization, including both overutilization and underutilization relative to clinical indications, is a significant problem affecting the quality of patient care, healthcare costs, and the workload of medical personnel. This study aimed to develop and evaluate a rational laboratory test ordering system by applying the principles of Rational Laboratory Use (RLU) in conjunction with personnel participation and digital technology. We asked whether the proposed system could reduce inappropriate test utilization and improve the continuity of patient care. This study employed a participatory action research design based on the PAOR cycle (Plan–Action–Observation–Reflection), conducted over two iterative cycles. Laboratory test utilization was compared between pre- and post-implementation periods, each spanning 12 months, along with the assessment of diabetes care quality and user acceptance among healthcare personnel. The results showed that the utilization of blood urea nitrogen (BUN), activated partial thromboplastin time (APTT), and free triiodothyronine (FT3) significantly decreased after implementation (p < 0.05). Meanwhile, the coverage of at least annual hemoglobin A1c (HbA1c) testing and the continuity of follow-up among patients with HbA1c ≥ 7.0% improved. User acceptance was rated at a good to very good level, particularly in terms of alignment with routine workflows and system sustainability. The findings suggest that the system can improve the appropriateness of laboratory test utilization and support patient follow-up in a community hospital setting.
References
Müskens JLJM, Kool RB, van Dulmen SA, Westert GP. Overuse of diagnostic testing in healthcare: a systematic review. BMJ Qual Saf 2022; 31(1): 54-63.
Kroner GM, Richman S, Fletcher A, Dickerson J, Jackson BR. Current state of laboratory test utilization practices in the clinical laboratory. Acad Pathol 2022; 9(1): 100039. (4 pages).
Cadamuro J, Gaksch M, Wiedemann H, Lippi G, von Meyer A, Pertersmann A, et al. Are laboratory tests always needed? Frequency and causes of laboratory overuse in a hospital setting. Clin Biochem 2018; 54: 85-91.
Alshekhabobakr HM, AlSaqatri SO, Rizk NM. Laboratory test utilization practices in Hamad Medical Corporation; role of laboratory supervisors and clinicians in improper test utilization; a descriptive pilot study. J Multidiscip Healthc 2022; 15: 413-29.
Zayed AM, Delvaux N. Analyzing laboratory test utilization trends in Belgian primary care: a decade of insights with international perspectives. BMC Prim Care 2024; 25: 270. (9 pages).
World Health Organization. The selection and use of essential in vitro diagnostics: report of the fourth meeting of the WHO Strategic Advisory Group of Experts on In Vitro Diagnostics, 2022 (including the fourth WHO model list of essential in vitro diagnostics). Geneva: World Health Organization; 2023.
Gill J, Barakauskas VE, Thomas D, Rodriguez-Capote K, Higgins T, Zhang D, et al. Evaluation of thyroid test utilization through analysis of population-level data. Clin Chem Lab Med 2017; 55(12): 1898–1906.
Capoor MN, Stonemetz JL, Baird JC, Ahmed FS, Awan A, Birkenmaier C, et al. Prothrombin time and activated partial thromboplastin time testing: a comparative effectiveness study in a million-patient sample. PLoS One 2015; 10(8): e0133317. (13 pages).
Mathura P, Boettger C, Hagtvedt R, Sweeney C, Williams S, Suranyi Y, et al. Reduction of urea test ordering in the emergency department: multicomponent intervention including education, electronic ordering, and data feedback. CJEM 2022; 24(6): 636–40.
Adaji A, Schattner P, Jones KM, Beovich B, Piterman L. Care planning and adherence to diabetes process guidelines: Medicare data analysis. Aust Health Rev 2013; 37(1): 83–7.
Renard LM, Bocquet V, Vidal-Trecan G, Lair ML, Blum-Boisgard C. Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in Luxembourg. PLoS One 2013; 8(11): e80162. (9 pages).
Mikhaeil M, Day AG, Ilan R. Non-essential blood tests in the intensive care unit: a prospective observational study. Can J Anaesth 2017; 64(3): 290-5.
Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One 2013; 8(11): e78962. (8 pages).
O'Sullivan JW, Stevens S, Hobbs FDR, Salisbury C, Little P, Goldacre B, et al. Temporal trends in use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests. BMJ 2018; 363: k4666. (8 pages).
Aldiba MA, Jamali EM, Dighriri A, Abdulhaq AM, Ali MR, Otaif AM, et al. Rationalisation of laboratory tests ordering and consumption at Armed Forces Hospital, Jazan. BMJ Open Qual 2023; 12(2): e002114. (7 pages).
Devis L, Catry E, Honore PM, Mansour A, Lippi G, Mullier F, et al. Interventions to improve appropriateness of laboratory testing in the intensive care unit: a narrative review. Ann Intensive Care 2024; 14(1): 9. (32 pages).
Kanwar G, Rathore S, Khandelwal A, Khandelwal D, Khandelwal A, Meena R, et al. A study of rational use of investigations in a tertiary hospital. Asian J Med Sci 2022; 13(10): 121-5.
Shirazi M, Masoudian Y, Feizabad E, Golshahi F, Ghaemi M. Creating a novel strategy to reduce unnecessary laboratory testing based on healthcare cost analysis in high-risk pregnancies and delivery ward. J Clin Lab Anal 2021; 35(5): e23759. (4 pages).
Greenhalgh T, Wherton J, Papoutsi C, Lynch J, Hughes G, A’Court C, et al. Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res 2017; 19(11): e367. (21 pages).
World Health Organization. Global strategy on digital health 2020-2025. Geneva: WHO; 2021.
Arnaudeau S, Nickum M, Fouquereau E, Chevalier S, Gillet N, Mokounkolo R, et al. The participatory approach in healthcare establishments as a specific French organizational model at hospital department level to prevent burnout among caregivers: what are the perceptions of its implementation and its potential contributions by these caregivers?. Int J Environ Res Public Health 2024; 21(7): 882. (16 pages).
Seward N, Hanlon C, Hinrichs-Kraples S, Lund C, Murdoch J, Taylor Salisbury T, et al. A guide to systems-level, participatory, theory-informed implementation research in global health. BMJ Glob Health 2021; 6(12): e005365. (16 pages).
Verweij L, Metsemakers SJJPM, Ector GICG, Rademaker P, Bekker CL, van Vlijmen B, et al. Improvement, implementation, and evaluation of the CMyLife digital care platform: participatory action research approach. J Med Internet Res 2023; 25: e45259. (14 pages).
Kemmis S, McTaggart R, editors. The action research planner. 3rd ed. Victoria: Deakin University Press; 1988.
Vaughn LM, Jacquez F. Participatory research methods-choice points in the research process. J Particip Res Methods 2020; 1(1): 1-14.
Cornish F, Breton N, Moreno-Tabarez U, Delgado J, Rua M, de-Graft Aikins A, et al. Participatory action research. Nat Rev Methods Primers 2023; 3: 34. (14 pages).
ชูศักดิ์ เอกเพชร. การวิจัยปฏิบัติการ (Action Research). สุราษฎร์ธานี: คณะครุศาสตร์ มหาวิทยาลัยราชภัฏสุราษฎร์ธานี; 2561.
Best JW, Kahn JV. Research in education. 10th ed. Boston: Pearson Allyn and Bacon; 2006.
Rabbani N, Ma SP, Li RC, Winget M, Weber S, Boosi S, et al. Targeting repetitive laboratory testing with electronic health records-embedded predictive decision support: a pre-implementation study Clin Biochem 2023; 113: 70-7.
Prokop LJ, Srinivasan V, Koepplinger ME, Groth SL, Cossack RL, et al. The effect of computerized clinical decision support systems on laboratory test ordering: a systematic review. Arch Pathol Lab Med 2017; 141(3): 367-75.
Yeshoua B, Bowman C, Dullea J, Ditkowsky J, Shyu M, Lam H, et al. Interventions to reduce repetitive ordering of low-value inpatient laboratory tests: a systematic review. BMJ Open Qual 2023; 12(1): e002128. (7 pages).
Glauser E. Implementing an evidence-based protocol to reduce inappropriate laboratory test ordering. J Nurse Pract 2022; 18(10): 1078-80.
Gerwer JE, Bacani G, Juang PS, Kulasa K. Electronic health record-based decision-making support in inpatient diabetes management. Curr Diab Rep 2022; 22(9): 433–40.
O’Connor PJ, Sperl-Hillen JM, Rush WA, Johnson PE, Amundson GH, Asche SE. Impact of electronic health record clinical decision support on diabetes care: a randomized trial. Ann Fam Med. 2011;9(1):12-21.
Chen W, Howard K, Gorham G, O'Bryan CM, Coffey P, Balasubramanya B, et al. Design, effectiveness, and economic outcomes of contemporary chronic disease clinical decision support systems: a systematic review and meta-analysis. J Am Med Inform Assoc 2022; 29(10): 1757-72.
Sly B, Russell AW, Sullivan C. Digital interventions to improve safety and quality of inpatient diabetes management: a systematic review. Int J Med Inform 2022; 157: 104596.
Huang S, Liang Y, Li J, Li X. Applications of clinical decision support systems in diabetes care: scoping review. J Med Internet Res 2023; 25: e51024. (23 pages).
Carayon P, Wooldridge A, Hoonakker P, Hundt AS, Kelly MM. SEIPS 3.0: human-centered design of the patient journey for patient safety. Appl Ergon 2020; 84: 103033. (23 pages).
Peters S, Guccione L, Francis J, Best S, Tavender E, Curran J, et al. Evaluation of research co-design in health: a systematic overview of reviews and development of a framework. Implement Sci 2024; 19(1): 63. (16 pages).
Bayor AA, Li J, Yang IA, Varnfield M. Designing clinical decision support systems (CDSS)—a user-centered lens of the design characteristics, challenges, and implications: systematic review. J Med Internet Res 2025; 27: e63733. (19 pages).
Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit Med 2020; 3: 17. (10 pages).
Olakotan OO, Mohd Yusof M. The appropriateness of clinical decision support systems alerts in supporting clinical workflows: a systematic review. Health Informatics J 2021; 27(2): 14604582211007536. (22 pages).
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