Choosing Wisely Pathology Project

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Initiative Type
Redesign
Status
Close
Added
Last updated

Summary

The Choosing Wisely Pathology project is focusing on managing the demand and improving the quality use of pathology testing at Gold Coast Health.

Using clinical costing data as the source, the project team has created a rich dataset and interactive dashboard to allow clinicians to visualise their pathology utlisation along the patient pathway. The clinical teams review their pathology ordering, supported by data discovery and analysis efforts, to check for appropriateness and identify opportunities to improve testing practices. Having engaged closely with eight clinical teams to profile their pathology utilisation, there has been a notable reduction in the ordering of unnecessary pathology tests, despite an increase in activity. This directly benefits patient safety and experience, and enhances the value of healthcare through quality pathology testing.

Key dates
Jan 2016
Aug 2017
Implementation sites
Gold Coast University Hospital

Aim

  • Analyse and profile the current state of pathology ordering in terms of cost, volume, retest intervals, and other key metrics and benchmarks (by specialty and service area)
  • Determine clinical appropriateness and value of pathology ordering patterns against best practice.
  • Develop demand management strategies and solutions to improve pathology ordering practices

Benefits

  • Improved patient safety, care, and experience.

Background

The project was established in response to increasing expenditure and test volumes in public pathology services, a desire to provide better value care for patients, and to explore ways to better manage the demand for and improve the quality use of pathology testing at Gold Coast Health.

Solutions Implemented

The project has deployed an interactive and dynamic dashboard to maximise clinical opportunity and to monitor pathology utilisation. The pathology dashboard draws on the underlying rich clinical costing dataset, and comprises a series of interdependent graphs for further filtering and selection of ordering patterns.

Evaluation and Results

Strong clinical engagement and change management, accompanied by data and business-intelligence tools, has resulted in favourable project performance. A reduction in ordering unnecessary tests has been achieved through medical, nursing, and pathology representatives working together. Financial performance can be reflected through decreases in pathology test volumes and spend, despite increasing activity.

Since the project was implemented 15 months ago, the health service has seen a 2% drop in the number of tests ordered despite a 10% increase in patient activity. This in turn has reduced the pathology cost per weighted activity unit – a unique result in Queensland. From a quality and safety perspective, measures of solid performance include:

  • Reduction in inappropriate testing (mainly routine and repeat testing)
  • Increased education and learning
  • New access/visibility to utilisation data and reporting
  • Scrutiny and awareness of ordering practices
  • Consistency in pathology interventions across the patient flow and within specialist areas
  • Reduction of ‘no tests’ and other wasteful testing practices

Lessons Learnt

The central strength of the project involves clinicians discovering ways to improve pathology ordering practices, based on data and facilitation provided by the project team. This approach ensures durable change and ownership appropriately sits with the clinical teams. There is clear evidence that the improvements achieved in pathology ordering practices have been sustained well after the project team has tapered its frequency of interaction with clinical teams.

As key stakeholders in pathology testing, patients benefit from clinicians having better access to clinical information to make wise ordering decisions. Combined with robust engagement and decision support, pathology ordering is evolving into ‘value-based’ rather than ‘volume-focused’ testing.

The reduction of unnecessary pathology testing has created budgetary savings, helping ensure that the pathology dollar is spent wisely in times of increasing activity and resource allocation – which presents a shared purpose for all Queensland Health stakeholders.

Further Reading

Choosing Wisely Australia News: How one major health service is slashing pathology tests

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Key contact

Therese Kelly
Project Manager, Infectious Diseases and Immunology
Gold Coast Hospital and Health Service
(07) 5687 6490
Therese.Kelly@health.qld.gov.au

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