Wastage due to unnecessary laboratory test requests is a major problem in government hospitals because they have cost implications. Although screening of infectious marker tests such as Human Immunodeficiency Virus (HIV), Hepatitis B surface Antigen (HBsAg), Hepatitis B antibody (AHBS) and Hepatitis C Virus (HCV)) before testing have been put in place, inappropriate tests were still being carried out in the Serology laboratory, which resulted in wasted human resources and reagents, increased workload and increased maintenance costs. Based on the verification studies using the Laboratory Information System (LIS), we observed only 70% of the tests followed the ordering guidelines or test specifications. Thus, we aim to increase the standard to more than 95% of the infectious marker test requests which were appropriate according to a few guidelines.
A cross-sectional study was conducted for all infectious marker tests received at Serology Laboratory from January 2015 to June 2016 to verify the problem. A workplace audit and questionnaire survey on the staff were carried out to gain more information. Low level of knowledge, unavailability of standardised guidelines for quick and easy reference, lack of staff and inefficient work processes were among the main contributing factors. Empowering new staff to screen specimens, developing simple and informative screening guidelines, providing adequate trays and refrigerators for screening purposes and strengthening and developing a more effective process of care were the strategies taken during this study.
The appropriate tests carried out from July to September 2015, October to December 2015, January to March 2016 and April to June 2016 were 99%, 98.80%, 99.50%, 98.90% respectively. During the same period, 711, 411, 710 and 768 tests were rejected. We monitored the performance and managed to achieve 100% appropriate testing for the period of July 2016 to June 2018 and an estimation of MYR 73,437.50 cost saving was achieve