A comparison of different methods of demand management on requesting activity in a teaching hospital intensive care unit

Background Laboratory services in the UK have witnessed an annual increase in requesting activity often with no associated increase in budget. This study evaluated the impact of different demand management strategies on biochemistry test requesting activity from a tertiary Intensive Care Unit (ICU) at a UK teaching hospital. Method We conducted an observational longitudinal study in which biochemistry requesting activity from the ICU was gathered over five separate six-month periods between 2009 and 2013. During this time, two different strategies aimed at reducing inappropriate biochemistry requesting were in use and the effects of the two strategies were compared. Results Implementation of minimum re-testing intervals (MRIs) resulted in an overall 22.7% reduction in total requesting activity in the first year with minor change in clinical workload. In the second year, a 13.3% rise in requesting activity was seen but this was against a background of a 14.6% increase in ICU workload. Removal of the MRIs rules associated with the introduction of an ICU test testing schedule resulted in a 13.4% reduction in total requesting activity in the first year. ICU workload during this year was 1.8% lower than the previous year. In the final year, requesting activity was almost unchanged but ICU workload grew by 6.8%. Conclusion Implementation of MRIs reduced biochemistry test requesting activity on the ICU. Introduction of an agreed test schedule and removal of the MRIs, however, produced a further reduction in ICU requesting activity. Variation in ICU workload does not account for all the observed changes.