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Repertoire review | Outdated tests | Lack of consensus on removal of outdated tests |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 |