Lab Test Utilization: How Labs Can Improve Test Orders

A repeat order reaches the lab, but the patient already has a recent result. Lab test utilization starts with a practical question: what new information does this test need to provide?

What Is Lab Test Utilization?

Lab test utilization means the choice and timing of laboratory tests to answer a patient’s clinical question. Appropriate use includes tests that support diagnosis, treatment, or follow-up. It also aims to prevent unnecessary repeats, unsuitable tests, and gaps in needed care.

Laboratory test utilization management is the process by which a lab reviews these patterns and works with providers to improve them. ADLM’s test utilization resource addresses commonly misused tests and recommends better diagnostic practices. ADLM also advises labs to check whether each recommendation fits their patient population.

For lab directors and operations teams, the work starts with an order that deserves a closer look. The lab brings test expertise, prior results, and a clear reason for review. The provider supplies the clinical context and decides whether the patient needs the test.

A Complete Order Can Still Need Review

An order may contain every required field and still raise a utilization question. A provider may choose a familiar panel when a more targeted test would answer the question. Two practices may request the same test without access to each other’s results.

That separates utilization review from lab requisition errors. Requisition checks establish whether the request contains usable, accurate information. Utilization review asks whether the selected tests and timing fit the clinical purpose.

Three patterns deserve attention:

• Overuse: An additional test adds little useful information.
• Underuse: A patient misses a test that the care plan requires.
• Misuse: The chosen test does not fit the question, specimen, or clinical situation.

These patterns give the review a purpose beyond lower test volume. A useful program helps providers obtain information they need and identifies work that adds little value.

Test Orders That Deserve a Closer Look

Duplicate Orders and Early Repeats

Two orders for the same test do not automatically represent unnecessary care. A new symptom, a treatment change, or an earlier specimen problem may explain the repeat.

Consider a hypothetical example: two practices request the same test for one patient within a short period. Staff should first confirm the patient, exact test, collection dates, and status of the earlier order. An order in the system does not prove that the lab collected a specimen or produced a usable result.

If the earlier result is available, give the provider enough detail to decide whether it answers the current question. If the lab cannot access the relevant history, record that gap. No visible previous result does not mean no previous test.

Use test-specific review criteria that clinical leaders approve. Avoid one repeat interval for the whole test menu.

Broad Panels and Overlapping Tests

Panels offer convenience, but their contents can obscure what the provider actually needs. A separate test may already appear within a selected panel. A broad panel may also include results that would not affect the care plan.

A concrete example comes from ASCP’s respiratory panel recommendation. ASCP discourages routine broad respiratory pathogen panels unless the results will affect patient care. Its recommendation supports more targeted tests in suitable cases and broader tests when they could change treatment or infection-control decisions.

For the lab, this suggests a focused conversation about clinical purpose. A large panel alone does not establish inappropriate use. Review its components, the clinical question, and the provider’s reason before any authorized change.

Reflex Tests With Clear Criteria

Reflex tests add a defined next test only when an initial result meets specified criteria. For example, Mayo Clinic Laboratories’ thyroid cascade starts with TSH and adds free T4 when the TSH result meets its criteria.

This approach can help providers obtain a relevant next result without a separate request. The protocol needs a suitable patient group, clear triggers, and appropriate authorization. Explain the possible additional tests and charges in the catalog. Clinical leaders should define exceptions, since one cascade will not fit every patient.

Missed Tests and Follow-Up Gaps

Lower volume cannot show whether a lab has improved utilization. Some patients may need a test but never complete it.

Where the lab has access to the provider’s plan, compare expected tests with completed tests. A missed collection may reflect an access problem, a changed plan, or care at another facility.

For example, a patient may miss a test that the provider requested to assess treatment. Confirm that the request remains current before outreach. For standing orders, use the latest provider instructions rather than an older schedule.

An abnormal result alone does not authorize the lab to add tests. Route clinical follow-up questions to the responsible provider.

How to Start a Lab Test Utilization Review

A practical first project can focus on one test family and one recurring problem. Possible starting points include apparent duplicate orders, overlapping panel components, or repeats that fall outside an agreed review interval.

Choose a problem your team can investigate with the data it actually has. A rule that depends on inaccessible records will create requests for clarification without a reliable way to resolve them.

Define the Review Before You Add an Alert

The lab director and relevant providers should agree on the clinical criteria. Include staff who understand the order system and the workload that review creates. Assign an owner to update the criteria when evidence, assays, or patient needs change. Operations staff should then define what happens when an order meets those criteria:

For an independent lab, a useful starting approach is an agreement with one referring practice about which cases need clarification. For a hospital lab, the same project may involve changes to an electronic order set.

Match the response to the risk. A routine utilization question and an urgent clinical request need different routes. Define that distinction before staff face a time-sensitive case.

Send a Question the Provider Can Answer

A vague alert such as “possible unnecessary test” leaves the provider to reconstruct the issue.

A more useful message identifies the test, relevant history, and decision. For a hypothetical repeat order:

“We received another order for [test]. Our lab completed the same test on [date], and the result is available at [location]. Does the current request address a new clinical need, or can the earlier result answer the question? Please confirm whether to proceed.”

Staff should use only verified details and follow the lab’s secure communication policy. If no result is available, the message should say so.

Record the response where the team can retrieve it. If the provider confirms a valid repeat, preserve the reason. If the provider changes the order, preserve that authorization.

Fix the Pattern Behind Repeated Flags

Review the resolved cases together. If one template repeatedly produces overlapping orders, work with the practice to change the template. If staff confuse two similar test names, clarify the catalog labels.

Education works best here when it answers a specific problem. Give providers a short explanation of the relevant test choice or interval, with exceptions, instead of a general request to order fewer tests.

Keep Clinical Review Separate From Coverage Checks

Clinical review asks whether a test can help care for the patient. Coverage review asks whether the service meets the payer’s requirements. Keep separate records of these decisions.

For Medicare, CMS’s lab order requirements call for medical-record support for medical necessity. CMS also identifies documentation that the claim-submitting entity must retain.

A diagnosis code on a requisition does not, by itself, explain every clinical decision. When documentation is incomplete, seek the relevant information from the provider. Do not select another diagnosis simply to make a coverage check pass.

An alert should identify its basis: clinical review criteria, an order conflict, or a payer rule. That helps staff send the right question to the right person.

Measure Useful Decisions, Not Just Fewer Tests

For a first project, track a small set of measures:

Keep the eligible order group consistent. If the rule targets one panel, use that panel’s orders as the denominator rather than every order the lab receives.

As a hypothetical example, suppose staff flag 40 of 1,000 eligible orders and providers change 10. The flag rate is 4%, and the change rate among reviewed orders is 25%. The other 30 cases deserve attention too: valid exceptions may reveal a rule that needs adjustment.

Do not count every canceled order as a financial saving. A provider may replace it with another test, while manual review also consumes staff time.

Where Automated Order Checks Help

Automated checks can flag a recent repeat, a possible duplicate, or a mismatch between a test and the supplied diagnosis. Their value depends on what staff can see and do next: verify the relevant history, ask a specific question, and record the provider’s decision.

Docus’s AI Compliance Agent is one tool that supports these checks. Its flags can prompt review, while the provider decides whether the test fits the patient’s clinical needs.

Review confirmed exceptions as closely as changed orders. If staff repeatedly flag appropriate tests, refine the criteria. If one order template creates the same problem, address the template with the referring practice.