A large number of hospital patients are referred to haematology clinics, usually for bleeding disorders and thrombosis. An audit at the authors' hospital found that up to 89% of haematology tests for coagulation and chromogenic factors were requested unnecessarily. This quality improvement project was undertaken to reduce inappropriate requests for laboratory testing in the haematology department to improve efficiency and productivity at a hospital in Saudi Arabia. The team focused specifically on chromogenic and coagulation factor testing. Two plan-do-study-act (PDSA) cycles were implemented across a 2-year period. Interventions included staff education and use of the health informatics system to alert physicians to duplicate requests and allow communication between physicians and laboratory staff if requests were made inappropriately. The system was then configured to place restrictions on test requests for physicians who were not haematologists or related specialists. Data were collected on the number of chromogenic and coagulation tests requested and the proportion that were considered to be inappropriate, as well as associated costs. During the first PDSA cycle, the total number of requests fell from 632 to 52 per year, with the number of inappropriate requests falling from 372 to 25. By the end of the second PDSA cycle, the proportion of inappropriate requests was below 30%, with over half of all tests being requested by a haematologist. Substantial cost reductions were also observed. The authors believe that the methods used in this quality improvement projects could be replicated elsewhere to improve the efficiency of laboratory resource use.
Al‐Ansari et al. (Sat,) studied this question.
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