Investigation and assessment of the ‘assumed’ over-ordering of pathology tests in a private hospital-based pathology laboratory

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Coleman, Tina
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MBA in Business Management
Dublin Business School
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Dissertation Topic: This dissertation relates to the investigation and assessment of the ‘assumed’ over-ordering of pathology tests in a private hospital-based Pathology Laboratory. Objectives of Study: To review if there was in fact over-ordering of tests especially at weekends, to assess why his was happening, and who this could be attributed to, and if it could be controlled and/ addressed. Nature and Scope of Research Undertaken: A pluralistic approach was executed in relation this study whereby secondary data was obtained through management, business, medical pathology, operations and technology channels, informal discussions with colleagues, and data extrapolation from the Meditech Hospital Information System (HIS). As some of the activities outlined in this study had been under investigation and Action Plans were put in place at the very early stages including IT blocks, education re-correct ordering, and awareness re test costs. Additional Meditech data relating to the breakdown of tests, the areas where the tests were being ordered, and the consultants/ medical specialties responsible for the test ordering was also obtained and reviewed, as well as process review via Process Mapping and FMEA. Five medical consultants from the areas attributed to ordering the most tests or influencing the test ordering procedures in the Hermitage Medical Clinic were selected for In-Depth Interviews. Results: Data from May 2014 was analysed and this level of activity was assessed to ensure it was representative of the year as a whole. No apparent trends indicating over-ordering of tests were observed. The tests ordered were also representative of the patient cohort in the hospital, the areas the tests were ordered from, and the requesting clinicians. The number of biochemistry Full Profiles was highlighted however and this was discussed during the In-Depth interviews (IDIs). Conclusions: Over-ordering in essence is not taking place in the Hermitage Medical Clinic. Some situations could not be ruled out explicitly given the complex nature of the patients’ clinical presentations but the Consultants interviewed did have good knowledge and awareness with respect to test ordering processes. Contribution made to the Knowledge of the Topic Investigated & Further Study: The lack of definitive, reliable secondary data relevant to this study was apparent very early on and this study aims to highlight issues with potential for address, contribute information for improvement, while serving as a platform for further study particularly in relation to Pathology Laboratories and the private healthcare system in Ireland. Author keywords: Investigation, assessment, hospital, pathology laboratory