Appropriate laboratory utilization in diagnosing pulmonary embolism

Background: The appropriateness of clinical laboratory use in hospital clinical practice is a very debated question. In fact diagnostic tests are essential tools for disease screening or diagnosis but at the same time they represent an important expenditure. Methods: A quantitative study was conducted in an Italian general hospital with 535 beds and about 27,000 admissions per year. The sample was made of all patients discharged from the hospital with DRG 78 between the period 1 January 2005 and 31 December 2005. Results: The Emergency Department (ED) discharged 2.9% (116/4009) of patients with pulmonary embolism diagnosis in the year 2005. The percentage of prescription inappropriateness inferred by analysis of all required tests by operative unit was 21.7% (950/4385). The approximate estimate of the economic value of unnecessarily required tests was of 3495(sic). Of these 96.5% (112/116) had enlisting criteria. All haematological and clinical-chemical tests (11295) concerning studied patients were analysed. About 70.4% (93/132) of d-dimer tests were ordered in ED. In the studied patients, unfractionated heparin was administered in 17.8% (20/112) of the cases, low-molecular weight heparin in 79.5% (89/112) and heparin therapy was not administered in 2.7% (three of 112). Conclusion: This study uses a method to assess the quality of laboratory test orders using results as a tool to estimate the impact of economic resources devolved in executing inappropriate tests

Il difficile equilibrio tra qualit\ue0 attesa e risorse disponibili nei servizi in outsourcing: analisi di un servizio esternalizzato di pulizia in ospedale

The study analyses the performances of a hospital cleaning service managed in outsourcing with respect to the balance between available resources and expected quality standards. Data were referred to a high specialization hospital and were collected through a multiple approach (interviews, cost analysis, performance simulations and field investigations). A difference (48%) emerged between expected and observed standards. In order to quantify the estimated gap, two models were examined with respect to personnel costs (euro 7.09/hr for NHS personnel and euro 4.5/hr for private personnel). Additional resources needed to achieve required standards resulted respectively 182% and 115% of the invested budget. This result stresses the importance to define the minimum standard to be guaranteed for safe and clean environment in health care organizations and the break-even point between quality and costs, leaving the single institutions the decision about additional quality level and resources needed for it