Optimising pathology service use and efficiency post-COVID-19

Aim

A comprehensive review to identify and understand the contributing factors of increased pathology expenditure, and to identify potential opportunities to improve service utilization and financial efficiency.

Outcomes

There are five main findings:

1. The volume of all tests increased, with respiratory-related testing proportionally increasing the most, so that it is now the largest single contributor to pathology expenditure
2. There has been an increase in opportunistic screening in acute settings e.g. sexually transmitted infections (STIs)
3. Point Of Care (POC) testing increased and has become a cornerstone of clinical diagnostic pathology with opportunities to reduce duplication of tests
4. Non-clinical, operational pathology costs increased substantially and in excess of budget allocation
5. Workforce shortages, and staff recruitment and retention negatively impacts a viable and sustainable pathology service.

Background

Clinical pathology services are a significant non-labour cost for the South West HHS (SWHHS). Total annual pathology expenditure has increased over time, with the most substantial increases since the advent of the COVID-19 pandemic.

Discussion

The review informed four recommendations with implementation actions.

1. It is essential to build future budget according to the actual operational costs, PQ test pricing, and the projected increases in demand for services.
2. From a population health perspective, given the market failure of general practice in rural and remote regions, opportunistic testing needs to be encouraged within secondary care settings to decrease the burden of undiagnosed preventable and communicable diseases within the community.
3. The technology of POC testing is likely underutilised in rural and remote settings and innovative optimisations of emerging technology can greatly reduce CRP testing-related costs, as well as inter-hospital transfers.
4. Finally, there is scope for reducing service costs by highlighting and addressing non-clinical pathology costs that can be mitigated through educational interventions.

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