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. 1994 Sep;47(9):782–786. doi: 10.1136/jcp.47.9.782

Cost control of out-of-hours laboratory services in district general hospitals.

K D Allen 1
PMCID: PMC494930  PMID: 7962643

Abstract

AIMS--To survey methods for cost control of out-of-hours laboratory services in district general hospitals in England and Wales. METHODS--A questionnaire was distributed to 66 district general hospital laboratories in England and Wales. RESULTS--The response rate was 61%. Most laboratories for which budgetary information was provided had on-call costs ranging between 10-21% of staff costs. Ninety five per cent of respondents had attempted to reduce workload by the use of various strategies. Seventy two per cent of responding laboratories had negotiated a wide variety of on-call agreements outside Whitley Council arrangements. Seventy two per cent were not satisfied with their on-call arrangements, the main desired objective being the introduction of the extended working day. CONCLUSIONS--From this study it seems that Whitley Council agreements for out-of-hours work are no longer appropriate for the average district general hospital laboratory. Workload reduction strategies should include the use of a limited list, audit of the use of the on-call service, and continued education of medical staff. Consideration may also be given to the introduction of fixed payments, extension of the working day, increased multidisciplinary on-call and increased bedside testing.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bareford D., Hayling A. Inappropriate use of laboratory services: long term combined approach to modify request patterns. BMJ. 1990 Dec 8;301(6764):1305–1307. doi: 10.1136/bmj.301.6764.1305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bhatnagar D., Weinkove C., McMurray J. R. Suggested guidelines for the use of emergency tests in clinical biochemistry. J Clin Lab Anal. 1989;3(3):196–198. doi: 10.1002/jcla.1860030311. [DOI] [PubMed] [Google Scholar]
  3. Everett G. D., deBlois C. S., Chang P. F., Holets T. Effect of cost education, cost audits, and faculty chart review on the use of laboratory services. Arch Intern Med. 1983 May;143(5):942–944. [PubMed] [Google Scholar]
  4. Fleming P. R., Zilva J. F. Work-loads in chemical pathology: too many tests? Health Trends. 1981 May;13(2):46–49. [PubMed] [Google Scholar]
  5. Fraser C. G., Woodford F. P. Strategies to modify the test-requesting patterns of clinicians. Ann Clin Biochem. 1987 May;24(Pt 3):223–231. doi: 10.1177/000456328702400301. [DOI] [PubMed] [Google Scholar]
  6. Gama R., Nightingale P. G., Broughton P. M., Peters M., Bradby G. V., Berg J., Ratcliffe J. G. Feedback of laboratory usage and cost data to clinicians: does it alter requesting behaviour? Ann Clin Biochem. 1991 Mar;28(Pt 2):143–149. doi: 10.1177/000456329102800204. [DOI] [PubMed] [Google Scholar]
  7. Gama R., Nightingale P. G., Broughton P. M., Peters M., Ratcliffe J. G., Bradby G. V., Berg J. Modifying the request behaviour of clinicians. J Clin Pathol. 1992 Mar;45(3):248–249. doi: 10.1136/jcp.45.3.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gunn I. R., Little A. J., Payne R. B. Effects of workload and analysis time on the cost of out-of-hours investigations. Ann Clin Biochem. 1986 Sep;23(Pt 5):501–503. doi: 10.1177/000456328602300502. [DOI] [PubMed] [Google Scholar]
  9. Gyde O. H., Leyland M. J. Reducing the use of laboratory tests. Br Med J (Clin Res Ed) 1986 May 31;292(6533):1462–1462. doi: 10.1136/bmj.292.6533.1462-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Lester E. A new strategy for out-of-hours laboratory investigations. Ann Clin Biochem. 1986 Sep;23(Pt 5):497–500. doi: 10.1177/000456328602300501. [DOI] [PubMed] [Google Scholar]
  11. Martin A. R., Wolf M. A., Thibodeau L. A., Dzau V., Braunwald E. A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med. 1980 Dec 4;303(23):1330–1336. doi: 10.1056/NEJM198012043032304. [DOI] [PubMed] [Google Scholar]
  12. McKee M., Priest P., Ginzler M., Black N. Achieving consensus on out-of-hours laboratory tests. Ann Clin Biochem. 1992 Mar;29(Pt 2):214–219. doi: 10.1177/000456329202900217. [DOI] [PubMed] [Google Scholar]
  13. Mitchell M. W., Fowkes F. G. Audit reviewed: does feedback on performance change clinical behaviour? J R Coll Physicians Lond. 1985 Oct;19(4):251–254. [PMC free article] [PubMed] [Google Scholar]
  14. Morgan D. B., Gunn I. R., Faye S., Clegg G., Grant A. M. A comparison of alternative arrangements for an out-of-hours chemical pathology service. Lancet. 1985 Apr 13;1(8433):859–861. doi: 10.1016/s0140-6736(85)92217-2. [DOI] [PubMed] [Google Scholar]
  15. Rhyne R. L., Gehlbach S. H. Effects of an educational feedback strategy on physician utilization of thyroid function panels. J Fam Pract. 1979 May;8(5):1003–1007. [PubMed] [Google Scholar]
  16. Sandler G. Do emergency tests help in the management of acute medical admissions? Br Med J (Clin Res Ed) 1984 Oct 13;289(6450):973–977. doi: 10.1136/bmj.289.6450.973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Schroeder S. A., Myers L. P., McPhee S. J., Showstack J. A., Simborg D. W., Chapman S. A., Leong J. K. The failure of physician education as a cost containment strategy. Report of a prospective controlled trial at a university hospital. JAMA. 1984 Jul 13;252(2):225–230. [PubMed] [Google Scholar]
  18. Smith A. D., Shenkin A., Dryburgh F. J., Morgan H. G. Emergency biochemistry services--are they abused? Ann Clin Biochem. 1982 Sep;19(Pt 5):325–328. doi: 10.1177/000456328201900501. [DOI] [PubMed] [Google Scholar]
  19. Stilwell J. A., Young D., Cunnington A. Evaluation of laboratory tests in hospitals. Ann Clin Biochem. 1980 Nov;17(6):281–286. doi: 10.1177/000456328001700601. [DOI] [PubMed] [Google Scholar]
  20. Watson D. Analytical investigations closer to the patient. Br Med J. 1980 Jul 5;281(6232):31–35. doi: 10.1136/bmj.281.6232.31. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Young D. W. Improving laboratory usage: a review. Postgrad Med J. 1988 Apr;64(750):283–289. doi: 10.1136/pgmj.64.750.283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. van Heyningen C., Simms P. Guidelines for out-of-hours clinical chemistry investigations. Clin Chem. 1990 Dec;36(12):2151–2152. [PubMed] [Google Scholar]

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