Muhammad Tahir, Noshin Wasim Yusuf, Naureen Akhter Ali, Rabiya Tahir.
Appropriate ordering of liver function tests in a tertiary care hospital: a cost effective health service.
J Allama Iqbal Med Coll Jan ;7(4):30-4.

The data analysis (A retrospective study) to highlight the need of thoughtful ordering of laboratory tests was carried out (designed) in the chemistry section of Pathology Department, Allama Iqbal Medical College Lahore. The request forms during April 2008 and November 2008 from indoors of three medical units of Jinnah Hospital Lahore were included in the analysis. The ordinal qualitative data consisted of 10,517 samples ordering 74,771 tests at an average of 7.11 per sample. It did not include the routine hematological tests, urine examination and other laboratory tests of the same patient done in other sections of department of pathology. 6,927 out of a total of 10,517 request forms received from medical wards of Jinnah Hospital, Lahore carrying the tests demand for LFTs, Viral Markers and Albumin Globulin Ratio were identified with a non-probability sampling technique. They were placed in four groups i.e. Group A (Bilirubin, ALT and ALP), Group B (Bilirubin, ALT, AST and ALP), Group C (Bilirubin, ALT, AST, ALP, HBsAg and Anti HCV), Group D (Bilirubin, ALT, AST, ALP, HBsAg, Anti HCV and Serum Albumin). The rate contract award 2007-2008 of Jinnah Hospital, Lahore in local currency was consulted for calculating cost effectiveness. Total financial resources expended were RS 7, 10,211.The most frequently ordered laboratory tests were of Group D (44.84% , n = 3,106) and the cost incurred was Rupees 5, 71,845.70 which was 80.52 % of the total cost. The cost of analysis of laboratory tests included in Group A of the same number of cases of Group D (n = 3,106) comes out to be Rupees 36, 278.08 which was 5.11% of the total cost. The ratio of collective cost of Group D & collective cost of Group A tests was 15.76: 1. Conclusions Rational ordering of liver function tests and avoiding the whole parameter range can save substantial financial resources of the hospital. The saved financial resources can be used for the treatment of patients and many other aspects of health care. The clinicians have a great many tests at their disposal.

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