Laboratory Effectiveness: Clinical Laboratory Utilization

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Author: Kevin F. Foley, PhD, DABCC, MT, SC
Reviewer: Dina N. Greene, PhD, DABCC

In this course we define laboratory utilization and look at ways that the entire laboratory team can contribute to the laboratories utilization goals. Possible solutions to common utilization challenges are explored. Structuring a laboratory utilization team is discussed along with ways that laboratory professions can help guide clinicians to prevent misuse of laboratory services.

Continuing Education Credits


  • Define laboratory utilization or lab stewardship and its overall goals.
  • Discuss the scope of practice for the laboratory professional in a utilization management role.
  • List issues and potential solutions concerning major problem areas including:
    Outside (referred) lab testing, obsolete tests or tests of limited value, over-bundled tests, stat tests, the electronic medical record (EMR) as a tool, a lab formulary, frequency of testing, tests that should be restricted, and genetic testing.
  • Describe the structure of a laboratory utilization team.
  • Discuss ways in which the laboratory can help clinicians avoid underuse, overuse, and misuse of clinical laboratory services.

Course Outline

  • Laboratory Utilization Management
      • What is Laboratory Utilization Management (UM)?
      • The Problem
      • Evidence-Based Practice (EBP)
      • A goal of laboratory utilization management (UM) is to ensure that laboratory testing is both cost-effective and appropriately used.
  • Laboratory Utilization Management Team
      • Value of a Utilization Management (UM) Team
      • Who Should Be on an UM Team?
      • UM Team Meetings
      • UM Team Projects to Improve Laboratory Effectiveness
      • Which of the following is a good practice for a Laboratory Utilization Management (UM) team?
  • Laboratory Utilization Issues and Potential Solutions
      • Referred Laboratory Testing: the Laboratory Formulary Concept
      • The Formulary
      • Advantages of Instituting a Formulary
      • Obsolete Tests or Tests Not Recognized by CMS
      • Tests of Limited Value
      • Changing Ordering Habits
      • Ionized Calcium (iCa) as an Example
      • Overbundled Tests
      • Examples of Overbundled Tests
      • Defining Stats
      • Frequency of Testing (Outpatient)
      • Frequency of Testing (Inpatient)
      • Under-ordered or Misordered Tests
      • The Electronic Medical Record (EMR) as a Utilization Tool
      • The Electronic Medical Record (EMR) as a Utilization Tool, Continued
      • Laboratory Report Cards for Clinicians
      • Which of the following would be the MOST effective method for reducing excessive ordering on the same inpatient?
      • A laboratory formulary is a way to ensure proper staffing throughout the day.
  • Genetic Testing
      • Genetic Testing
      • Genetic Testing, continued
      • Getting a Handle on Genetic Tests
      • Genetic Testing Issues and Policies
  • Summary
      • Summary
  • References
      • References

Additional Information

Level of instruction: Intermediate

Intended Audience:  The target audience for this course is laboratory professionals (Medical Laboratory Scientists, Laboratory Directors, Pathologists, who act in an administrative capacity or would like to increase their knowledge regarding laboratory administrative issues. The course is also appropriate for Clinical Laboratory Science students.
Author information: Kevin F. Foley, PhD, DABCC, MT, SC is the Northwest chemistry, toxicology, immunology and POC director for Kaiser Permanente. He also teaches pharmacology, clinical chemistry, immunology and medicinal chemistry at Oregon Health Sciences University. Dr. Foley earned his PhD in clinical pharmacology and toxicology at East Carolina School of Medicine in North Carolina. His research areas include cardiovascular risk and inflammation markers as well as the neuropharmacology of amphetamine-like compounds. He is a frequent contributor to several clinical laboratory publications and is active in the American Association of Clinical Chemistry.
Reviewer information:  Dina N. Greene, PhD, DABCC is a Clinical Laboratory R&D Scientist for Kaiser Permanente Regional Laboratories, Berkeley , California. She holds a PhD in biochemistry, cell, and developmental biology from Emory University and is certified by the American Board of Clinical Chemistry. 

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