66 Evaluating the Impact of an Expanded Trainee-Led Miscellaneous Test Request Review Process on Laboratory Stewardship
Notice bibliographique
Résumé
Abstract Clinicians at our institution can request esoteric tests not included in the standard test menu through a miscellaneous order process. While this flexibility allows access to specialized testing, it also introduces possibilities of errors. To address these challenges, a trainee-led review process of miscellaneous requests for chemistry tests was established to systematically assess these requests. Since beginning the process, we have slowly expanded the review to include other disciplines of testing. With now over thirty months of data, we evaluated the effectiveness of the program and how it is changed since initialization. We conducted a retrospective analysis of miscellaneous test request reviews over thirty months. The review process was conducted using our laboratory information system (Epic Beaker) to flag tests for review after specimen collection. Pathology residents reviewed the flagged tests daily and logged them into a shared, secure Excel-based tracker. Residents consulted with medical directors from the relevant laboratory sections for guidance as needed, and a medical director conducted a final daily review to complete the process. Additionally, residents met with a medical director weekly to discuss test requests and evaluate the review workflow. Since establishment of the review process, 4,766 tests requests have been reviewed, increasing from 312 in the first quarter of the program to 569 in the most recent completed quarter due to gradual expansion of the review into non-chemistry disciplines. Requests originate from internal (61.3%) and external/client providers (38.7%). As expected, chemistry tests account for 89.4% of requests; the two next largest categories are microbiology (6.4%) and immunology (3.6%). Of all reviewed requests, 80.6% were approved without modification, while 5.2% were canceled due to redundancy or inappropriateness. An additional 11.7% were converted to a defined in-house test, 1.7% were redirected to an alternative reference laboratory, and 0.8% required modifications to the test ordered. Interventions in all categories except approvals increased over time, reflecting improved recognition of inappropriate or misrouted tests. The median time spent per review was 1 minute, with complex interventions, such as order modifications and redirections, requiring additional time (∼30 minutes). Expanding the scope of the review provided further insights into provider ordering patterns and opportunities for test stewardship initiatives. This review highlights the continued effectiveness of a trainee-led miscellaneous test request review process in optimizing test selection and utilization. The findings support ongoing efforts to engage trainees in laboratory stewardship initiatives to enhance efficiency, reduce inappropriate testing, and improve patient care. Additionally, this process has served as an educational tool, improving residents’ knowledge of esoteric testing and its appropriate use. To further strengthen this initiative, we plan to continue to expand this review process to other laboratory discipline, allowing residents to develop specialized expertise and contribute more effectively to test stewardship.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,017 | 0,079 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».