Tools for identifying targets for demand management
| Class | Parameter to assess | Examples of causes of inappropriate requesting |
|---|---|---|
| Workload statistics | Changes in test volumes over time | Initiation of non-commissioned services |
| Changes in referred work volumes | Poor training of junior staff, risk aversion | |
| Highest volume tests | Unfocussed requesting (‘It's available’) | |
| Highest cost tests | Lack of knowledge of test costs | |
| Appropriateness | Duplicate test frequency | Lack availability/awareness of guidance |
| Tests requested for specific scenarios | Poor training | |
| Benchmarking | Request patterns (volume/changes) from comparable requestors (eg, General practitioners (GPs)) | Inconsistency in training/awareness of guidance |
| Request patterns (volume/changes) relative to those of other laboratories | Specialist centre, patient demographics outliers, variability between laboratories in demand management strategies | |
| Rate of change relative to those of other laboratories | Variability between laboratories in demand management strategies, variability in guidance adoption, changes in laboratory/healthcare economy structure | |
| Test profiles relative to those of other laboratories | Lack of conformity to benchmarking recommendations | |
| Repertoire review | Outdated tests | Lack of consensus on removal of outdated tests |
| Profile composition | Lack of conformity to benchmarking recommendations | |
| Seniority of allowed requestor | Poor training of junior staff, logistical restrictions (usually information technology) on ability to develop selective requesting | |
| Guidance publication | Recommended additional testing | Guidance implemented without laboratory discussion (often undetected) |
| Recommended new tests | Initiation of non-commissioned services | |
| Audit | Results of clinical audit | Poor training, lack availability/awareness of guidance |
| Results of laboratory audit | Poor training, lack availability/awareness of guidance | |
| ‘Instinct’ | Clinically validated results | Wide range of possibilities |