Salwa Alansari - clinical biochemistry department

675 views
602 views

Published on

Published in: Health & Medicine, Education
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
675
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
18
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Salwa Alansari - clinical biochemistry department

  1. 1. Laboratory tests: a time for cutting off costs!<br />Dr. salwa Al-ansari<br />Clinical biochemistry department <br />Jaber al- ahmad armed forces hospital, Ministry of defense: kuwait<br />
  2. 2. Introduction:<br />Health care services<br />1- Preventive<br /><ul><li>Surveillances and epidemiology
  3. 3. Diseases control &prevention</li></li></ul><li>2- Mother r & Child<br /><ul><li>Pregnancy
  4. 4. Birth
  5. 5. Childhood</li></li></ul><li>3- Primary health services<br />Patient’s Every day health services:<br /><ul><li>Medical practitioner
  6. 6. Assistant health services</li></li></ul><li>Assistant health services<br /><ul><li>X- ray
  7. 7. Physiotherapy
  8. 8. Pharmacy
  9. 9. Clinical Laboratory
  10. 10. Ambulance & Paramedics …etc </li></li></ul><li>Clinical Laboratories:<br /><ul><li>Clinical Biochemistry
  11. 11. Hematology
  12. 12. Microbiology(incl. serology & Parasitology)
  13. 13. Histopathology</li></li></ul><li>Laboratory service providers:<br />Hospital based lab.<br />Physician based lab<br />Independent clinical lab<br />
  14. 14. Specialty:<br />Surgical specimen<br />blood transfusion and coagulation<br />CBC<br />Allergy<br />Acute phase reactants<br />
  15. 15. Full biochemical profile<br />Hormones<br />Tumor markers<br />Trace elements & Vitamins<br />Cultures<br />Urine routine<br />Semen analysis<br />…….etc<br />
  16. 16. Laboratory Tests:<br /><ul><li>Screening
  17. 17. Diagnostic
  18. 18. Treatment
  19. 19. Follow up</li></li></ul><li>Statistics: Depends?<br /><ul><li>Billions of tests yearly!
  20. 20. Important for patients!
  21. 21. Where is the problem ?
  22. 22. Not needed
  23. 23. Too often
  24. 24. Leads to more procedures
  25. 25. False +ve results</li></li></ul><li>24 hours working plan<br />Increased number of ordered tests<br />↑↑Pressure on the lab<br />More staffmore reagents <br />↑↑laboratory budget & Cost of service<br />
  26. 26. “WHO”: Many health systems are underfunded and even the well–<br />funded ones are under economic pressure due to increasing demand and cost inflation. In these scenarios, laboratory services are often accorded low priority<br />and inadequate allocation of “resources. <br />
  27. 27. ≈ 70% of health decisions involving laboratory results<br />>10 % total hospital admission tests.<br />≈ lab cost 24 % hospital bill<br />
  28. 28. Increased # tests? Is it crucial?<br /> Responsibility??<br /><ul><li>80 % clinicians
  29. 29. Patients</li></li></ul><li><ul><li>Staff
  30. 30. Companies or new technology
  31. 31. Internet
  32. 32. Preventive measures</li></li></ul><li>Cost of a test:<br />1- Variable:<br /><ul><li>Operating expenses & reagnets
  33. 33. Stat testing
  34. 34. Salaries
  35. 35. troubleshooting</li></li></ul><li><ul><li>Replacement parts
  36. 36. Re-running controls & specimens
  37. 37. Overtime?
  38. 38. Delayed results ->-> ↑↑length of stay</li></li></ul><li>2- Fixed:<br /><ul><li>Administrative
  39. 39. Equipment
  40. 40. Building
  41. 41. Electricity & water</li></li></ul><li>Costs:/ Kuwait<br />Ministry health :3rd largest public sector employer.<br />Total expenditure on Health: 6.7 % budget (2002-2003).<br />
  42. 42. Non profit community hospital <br />Average biochemical routine tests cost 3-10 k.D<br />Special tests 2.5-321.5 k .D<br />
  43. 43. <ul><li>10% of tests results left uncollected!
  44. 44. Tests re- 0rdered again after couple of weeks
  45. 45. Extra –tests added </li></li></ul><li>j. A. A.F.H capacity ≈ 200 beds<br />Average samples 15359 / month.<br />clin. Biochemist. :an attempt to ↓ unnecessary test during October 2010.<br />
  46. 46. Total lab. Tests number was average <br /> but:<br />Biochemical tests ↑ 121 %. Calculate the cost?<br />Was is it necessary????<br />
  47. 47. 10/08 8/08 5/08 6/0812/08 6/08 4/08 1/09 3/09 5/09 4/09 10/09 1/10 3/10 4/10 5/10 6/10 8/10 10/10<br />Number of tests carried out during specified months (2008-2010)<br />
  48. 48. October 2010<br />Number of tests for clinical biochemist. Depart. During October 2008-2010<br />
  49. 49. Still too many results not collected<br /><ul><li>Why? !
  50. 50. Any effect on service quality?
  51. 51. Are there any corrective measures?</li></li></ul><li>Our step:<br /><ul><li>Single central
  52. 52. Very. Small
  53. 53. Limited duration</li></li></ul><li>What we need ?<br /><ul><li>Inform the patients and clinicians cost of each test.
  54. 54. Cost analysis study “experience studies”.
  55. 55. Establish lab ethics & roles</li></li></ul><li><ul><li>Share information: clinicians (causality ,outpatients) & lab.
  56. 56. Physicians education programs
  57. 57. Government price control .</li></li></ul><li><ul><li>National Standardization
  58. 58. Correct the implemented decentralization, privatization and commercialization</li></li></ul><li><ul><li>Strengthen laboratories to provide critical inputs in making informed decisions
  59. 59. Multiple strategies & communications.
  60. 60. Changing the Disease specific lab.</li></li></ul><li>Financing<br />Improved health (level & quality)<br />Health Workforce<br />Access<br />Coverage<br />Responsiveness<br />Information<br />Social financial risk protection<br />Medical products & technologies<br />Quality<br />Safety<br />Improved efficiency<br />Service delivery<br />Leadership/Governance<br />WHO Health system Framework; Geneva, WHO , 2007<br />
  61. 61. Assay performance<br />Sensitivity<br />Specificity<br />Reproducibility<br />Supplemental testing<br />Quality assurance<br />Turnaround time<br />Specimen collection<br />Predictive values<br />Specimen type<br />Symptoms<br />gender<br />Instrumentation<br />Throughputs<br />Facilities <br />personnel<br />Cost effectiveness<br />Cost benefit<br />Cost utility<br />Epidemiology<br />Prevalence<br />Clinical setting<br />Risk indicators:<br />Demographic<br />Behavioral and clinical variables<br />Cost<br />Testing costs<br />Non testing cost<br />Selective screening presumptive treatment<br />Consideration for appropriate selection and use of laboratory tests. From Pfister. Reprinted with permission of the university of Wisconsin Board of Regents<br />
  62. 62. References<br /><ul><li>WHO. Asia pacific strategy for strengthening health lab. Services (2010-2015).
  63. 63. A. Robinson. Rationale foe cost effective lab. Medicine. Clin Microbiol.Rev. 1994:185-199.</li></li></ul><li><ul><li>N. Shatnawi, W. Hayienh , others. The role of clinical practice guidelines in reducing lab. Health care expenditure in developing country. J app Sc 2008. 8(19): 3508-3512.
  64. 64. Occupational Outlook handbook , 2010-11, Edition. http://www.bls.gov/oco/home.htm</li></li></ul><li>Special thanks<br />Conference Organizers<br />Our Lab Staff <br />Audience<br />

×