Measuring the cost of inefficient use of laboratory resources: Ecuador

The Quality Assurance Project (QAP) investigated strategies for increasing efficiency in hospital laboratory services, an area of hospital operations that is frequently identified as high cost. The study developed measurement methodologies for seven separate sources of economic waste in hospital laboratories (unneeded tests, unclaimed tests, resource use inefficiency, staffing inefficiency, expired reagents, poor quality control, and inefficient procurement) and tested them in three public hospitals in Ecuador. The methodologies were intended to provide rapid assessments of the economic waste in each source and so relied on data from existing hospital records and relatively short turnaround surveys. Estimates of economic waste were made for each source by comparing actual measured costs to what the costs would have been if standards were met. The application found that the measurement methodologies were useable, in the sense that they could be applied and the requested data obtained. We found thateconomic waste from unneeded tests and staffing inefficiency may be very large. Findings on a sample of unneeded tests in six disease categories (acute diarrhea in children and adults, pneumonia in children and adults, appendicitis, cholecistitis) indicated that roughly half were unneeded and may represent economic waste. This result is based on clinical standards for lab tests developed through consensus by each hospital and may not apply to other disease categories. The economic waste of staffing inefficiency was estimated to range from 15% to 25% of the total laboratory budget across the three hospitals. However, these figures probably overstate the actual economic waste due to over-staffing because they do not account for staff time spent on indirect and other productive tasks. Economic waste from inefficient procurement of reagents and materials was estimated to be very high at one of the three hospitals due to lack of systematic competitive bidding. Additional refinement of the measurement methodologies is needed to obtain information that is valid and useful. This report identifies the areas that need to be strengthened in each methodology. Some examples: the need to develop clinical standards for lab tests was not originally envisioned, and the successful development of standards for six disease categories needs to be extended to other categories to ensure a representative selection that can be generalized to all test. Poor record keeping and erratic discard practices for unclaimed tests and expired reagents suggest that improved ongoing monitoring and reporting of these problems may be necessary to acquire valid data. Information on the cost of benefits and other payroll costs should be incorporated into the staffing inefficiency methodology, along with information on all productive tasks carried out by laboratory staff. These and other refinements would improve the validity of the methodologies. Finally the issue of double counting needs to be addressed as such information is incorporated into management decision making. (author's)

Report Author(s): 
Abdallah H | Ayabaca P
Organization(s): 
Quality Assurance Project
ASSIST publication: 
no
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