AJLM2401 - CME/CMLE - A 5-step root cause analysis model for test overutilization: a study on its application to plasma transferrin testing-A 5-step root cause analysis model for test overutilization: a study on its application to plasma transferrin testing

A 5-step root cause analysis model for test overutilization: a study on its application to plasma transferrin testing

Pdf Summary

In a recent study published in the American Journal of Clinical Pathology, researchers from Mahidol University, Thailand, developed a five-step Root Cause Analysis (RCA) model aimed at addressing laboratory test overutilization. This model was applied specifically to plasma transferrin overordering, a common issue at Siriraj Hospital's Clinical Pathology Department. The study outlines that laboratory test overutilization, representing about 20% of all tests, leads to increased costs and potential negative impacts on patient care, including misdiagnosis and unnecessary procedures.<br /><br />The proposed RCA model consists of:<br />1. Problem Identification<br />2. Causal Factor Determination<br />3. Data Collection<br />4. Significant Factor Identification<br />5. Corrective Action Development and Outcome Measurement<br /><br />This approach allowed the identification of 22 root causes for transferrin overutilization, with major factors being confusion between transferrin and transferrin saturation, and unfamiliarity with the laboratory handbook. An educational infographic was created to address these issues and resulted in a significant decrease in unnecessary transferrin orders among clinicians (84.9%, P < .001) and nurses (46.8%, P < .001).<br /><br />The researchers conducted a comprehensive review of existing RCA protocols and utilized tools such as the Ishikawa diagram (Fishbone diagram) and Pareto charts to systematically identify and address the causes of overutilization. They then collected data through questionnaires distributed to clinicians and nurses and used statistical methods to analyze pre- and post-intervention ordering behaviors.<br /><br />Key findings revealed that the primary human factors contributing to overutilization were a lack of knowledge and confusion about test indications. Material and machine factors, including unawareness of the laboratory handbook and difficulties with electronic ordering systems, also played significant roles.<br /><br />The study concludes by emphasizing the importance of RCA in laboratory utilization management (LUM) and recommends that laboratories adopt this model to improve patient care and resource allocation. The success of educational interventions highlighted in the study suggests a potential for further refinement and implementation of similar RCA-based strategies in different laboratory settings.

Keywords

Root Cause Analysis

laboratory test overutilization

plasma transferrin

Mahidol University

Siriraj Hospital

Clinical Pathology

educational intervention

Ishikawa diagram

Pareto charts

patient care