A cost-effective interdisciplinary approach to microbiologic send-out test use.

CONTEXT: Use of reference laboratories for selected laboratory testing (send-out tests) represents a significant source of laboratory costs. As the use of more complex molecular analyses becomes common in the United States, strategies to reduce costs in the clinical laboratory must evolve in order to provide high-value, cost-effective medicine. OBJECTIVE: To report a strategy that employs clinical pathology house staff and key hospital clinicians in the effective use of microbiologic send-out testing. DESIGN: The George Washington University Hospital is a 370-bed academic hospital in Washington, DC. In 2012 all requisitions for microbiologic send-out tests were screened by the clinical pathology house staff prior to final dispensation. Tests with questionable utility were brought to the attention of ordering clinicians through the use of interdisciplinary rounds and direct face-to-face consultation. RESULTS: Screening resulted in a cancellation rate of 38% of send-out tests, with proportional cost savings. Nucleic acid tests represented most of the tests screened and the largest percentage of cost saved through screening. Following consultation, requested send-out tests were most often canceled because of a lack of clinical indication. CONCLUSIONS: Direct face-to-face consultation with ordering physicians is an effective, interdisciplinary approach to managing the use of send-out testing in the microbiology laboratory.

The ever-widening training-practice gap.

The quality of health care in this country depends, in part, on the quality of physician training. Educators in graduate medical education (GME) increasingly are concerned that residency training is not keeping pace with the changing demands of medical practice. This widening training-practice gap creates challenges for physicians entering practice, burdens physician employers with educational responsibilities, and has the potential to negatively affect the quality of health care. This article reviews the data supporting these concerns, considers how GME arrived at this state, and suggests a number of steps that need to be taken to begin to narrow the training-practice gap.