Reasons to remove a test from a laboratory menu:
(1) obsolete
(2) provides duplicate information to another test
(3) underutilized
(4) prohibitively expensive
(5) not being reimbursed
(6) can no longer be afforded in a time of budgetary cuts
Questions:
(1) Is the test essential for some critical process?
(2) Is the result needed STAT?
(3) Can a specimen be shipped economically to another laboratory for testing?
(4) Does testing need to be done immediately, so the patient needs to be on site for testing?
Costs of a test:
(1) cost of kits, reagents and instrumentation
(2) cost of controls
(3) cost of technologist time
(4) proficiency testing
(5) management overhead
A hospital committee on laboratory utilization can be a good way to make decisions in a politically acceptable way.
If a decision has been made to remove a test, then the medical and nursing staffs need to be notified. This is particularly important if the test is heavily utilized. It is also prudent to ask input from people who order the test most frequently.
If the test is to be discontinued entirely, then steps should be taken to remove the test name from paper forms and online physician ordering menus.
