185 Testing Cost reduction to Improve Quality of Care and Patient Safety in The Municipal Public Health System Based Ambulatory Care Clinics In New York City

Introduction/Objective Our New York City Municipal Public Health System based multi-site ambulatory clinics that offer various waived POCT (point of care tests) and provider-performed microscopy (PPM) to our communities, ensure standardization and quality of POC testing performed in-house and optimization of the appropriate all other send-out tests to the reference laboratories across our health system. Our laboratory service conducts system-wide centralized implementation, monitoring and oversight of the laboratory operations regarding regulatory compliance, test performance, quality control and training. As part of the Laboratory Quality improvement (QI)/Quality Assurance (QA) program, we conducted a comprehensive cost analysis of laboratory testing to identify areas where costs can be reduced or optimized and can be implemented system-wide to improve the quality of care without affecting patient safety. Methods/Case Report We focused on identifying areas where resources are being overused, wasted and or less utilized leading to opportunities for cost savings through better resource management and through reducing unnecessary testing. Results Among the performed in-house POCT tests, urine toxicology has been identified, which is least utilized per resource allocation. The tuberculosis screening test: an interferon-γ release assay (IGRA) was found as the most overutilized among the send out tests. Removal of the least utilized POCT would save the cost of the kit or reagent, technical oversight and time and optimization of the overutilized send out test would make sure that lab tests are performed appropriately and only when clinically indicated and compliant to the policy, leading to fewer testing and lower costs. Conclusion Since cost reduction is an important component of clinical laboratory quality improvement (QI) efforts and an ongoing process, by identifying and implementing new ways our laboratory services quality initiatives ensure efficiency and reduce expenses, the quality of testing for patient safety and care across our health system.