Demand optimisation in laboratory medicine phase V: final report June 2022

3. Aims

3.1 Demand Optimisation Programme Aims

It has been widely accepted and demonstrated that there is considerable variation in the use of diagnostic tests across the NHS.^[3] While some of this variation may be attributed to clinical and demographic differences, the degree of variation suggests an element of over-requesting and under-requesting, or unnecessary repeat testing. This is amplified by lack of availability or awareness of certain tests within some NHS Boards.

The demand optimisation programme aims to minimise over-requesting and under-requesting as well as reducing unnecessary repeat testing, all of which may be detrimental to patient care.

In addition to more efficient use of resources within diagnostics, optimisation of diagnostic testing is associated with more effective patient care pathways, driving appropriate and timely patient diagnoses and impacting patient flow and treatment.

In some cases, earlier testing can improve patient outcomes. Equally, unnecessary over-requesting can lead to a detrimental impact on clinical pathways. Unnecessary testing also costs money that could be utilised more effectively at other stages of the pathways of care.

3.2 Phase V Objectives

The work of the NDOG aligns with the ethos of the Realistic Medicine approach; ensuring that people receive appropriate and beneficial care that is evidence-based and in line with their preferences.

The objectives for Phase V of the programme are outlined below.

National Team Objectives:

• Establishment of QI toolkits to be utilised within all Health Board QI projects and teams
• Embed Primary Care QI portal into Health Improvement Scotland (HIS) platform
• Develop and roll out flash reports and test feedback reports
• Refine Primary Care Atlas of Variation and recovery monitoring dashboards
• Ongoing national data collection and population of data
• Strengthen links with Realistic Medicine leads and Demand Optimisation teams across Scotland
• Formal national rollout of the Primary Care Atlas of Variation and recovery monitoring dashboards
• Re-engage with Local Improvement Support Teams (LIST) to develop plans for tackling variation.

Network / Clinical Stakeholder Objectives:

• Identify relevant clinical pathways to target for streamlining processes and tackling variation across all Health Boards where appropriate

Board Level objectives:

• All Health Boards to submit data for the Atlas of Variation and recovery monitoring dashboards
• Actively promote use of QI toolkits and embed within local practice

Phase V milestones and progress against these are outlined in Annex 1.