National Demand Optimisation Group (Ndog) – Phase 3 Report

8 Conclusions

Demand Optimisation of laboratory testing remains vitally important so that test use and availability is appropriate in the Scottish NHS. This will help ensure scarce resource is not wasted and patient outcomes are optimised.

The development of a Scottish Atlas of Variation for Laboratory tests has been a major achievement. It clearly demonstrates significant unwarranted variation in laboratory test use and availability. Phase III has further developed and refined the Atlas, with pilot dashboard summary views developed for both GP and Laboratory professional groups to interrogate and use as a basis to consider test use and availability.

Data Collection to populate the Atlas has now stretched to cover 3 individual years (2017, 2018 and 2019). While manual collection of data remains the only current option, this has been streamlined and has become routine for some NHS Board Laboratory Services. Laboratory IT support needs strengthened across the health boards to enable data collection to continue, especially given the increased demand during the pandemic for such personnel. Snapshot reports, focusing on requesting patterns for individual tests along with educational guidance on appropriate test use, have also been developed for some of the tests within the Atlas.

Considerable stakeholder engagement around the work of the group is ongoing, notably with the Atlas of Variation, which has been very well received.

The COVID-19 pandemic has had a major impact on the programme, which was largely paused in March 2020. Ongoing data collection, Atlas of Variation pilots and associated educational interventions did not progress fully as planned and outcome data following interventions are not currently available to share.

The focus of the programme has therefore shifted to monitor laboratory test use during the COVID-19 pandemic and recovery phases – this has begun as Phase IV of the programme. It is anticipated that such data collection, analysis and subsequent dashboards can help identify healthcare gaps created during the pandemic and inform prioritisation decisions during remobilisation. In addition, identifying laboratory workflow issues, especially as remobilisation progresses, will enable laboratory resource pressures to be identified and addressed more easily.