Rational laboratory use in a tertiary care hospital: a case study of Burapha University Hospital

Abstract

Introduction: Laboratory testing is a critical component of patient diagnosis and clinical management. A substantial body of evidence indicates widespread overutilization of laboratory investigations across various healthcare settings, leading to increased costs, higher workload for healthcare personnel, and potential patient harm. The concept of Rational Laboratory Use (RLU) has therefore been developed to promote evidence‑based and appropriate use of laboratory resources.

Objectives: The goal is to propose system‑level recommendations for developing rational laboratory utilization guidelines within the Department of Internal Medicine Burapha University Hospital (BUH).

Methods: RLU principles at both international and national levels were reviewed, survey data were analyzed from questionnaires completed by medical personnel at BUH. Both qualitative and quantitative analyses were conducted to identify factors contributing to laboratory overutilization and to determine high‑risk tests prone to inappropriate use.

Results: Key factors driving unnecessary laboratory ordering included defensive medicine, habitual practice, overly broad order sets, user‑friendly HIS interfaces that facilitate excessive clicking, and hierarchical pressure from senior staff. Frequently cited laboratory tests included HbA1c, blood gas, CBC, electrolytes, creatinine, LFT panel, troponin, NT‑proBNP, culture, and TFT. System‑level recommendations include developing test‑specific clinical practice guidelines, implementing HIS soft‑stop/hard‑stop mechanisms, restructuring order sets, and providing ongoing education combined with audit and feedback.

Conclusion: The development of RLU at BUH represents an important example of translating evidence into practice. The next step is to implement a three‑month roadmap with clear KPIs to reduce unnecessary testing, lower hospital costs, and strengthen the sustainability of the healthcare service system.