Towards appropriate laboratory test utilization: A narrative overview

Increasing expenses and complex economic issues raise the need to redesign healthcare in a costeffective way while retaining the quality of care. Laboratory medicine plays an indispensable role in modern health care. Optimizing appropriate laboratory test utilization could reduce healthcare cost while enhancing quality of care. Literature search was done using pub-med electronic database among the studies published between January 1975 and April 2024 with search words ‘inappropriate’, ‘utilization’ and ‘laboratory tests’. Manual search of journal services and textbooks as well as reference articles were also done. Among them, studies on the landscape of inappropriate laboratory testing, possible causes, consequences, rationale for appropriate laboratory testing, strategies to improve appropriateness and the effectiveness of the interventions were included by screening the title and abstract. Studies on imaging and blood products requests were excluded. The proportion of inappropriate tests among studies varied extensively ranging from 4.5% to 95%. Based on a meta-analysis and systematic review published in 2013, overall mean rates of over and underutilization were 20.6% and 44.8% respectively. Numerous strategies have been employed both independently and in combination to overcome inappropriate utilization of laboratory resources. Laboratory diagnostic algorithms, clinical decision support systems/tools (CDSS/CDST), interventions within computerized provider order entry (CPOE), education and guidance, audits and feedback, gate keeping strategies, harmonization of test panels and request form design, and review of offered tests are some of them. Laboratory professionals can raise awareness of the need to change practice towards more appropriate requesting behavior.