If a hospital system or laboratory develops a list of tests that are being over-ordered or ordered inappropriately, how might the UM team proceed in addressing these issues?
Changing ordering habits is the most challenging aspect of UM. Much depends on how the UM team approaches their physician colleagues. The clinical laboratory should be integrated into the organization's care structure. Lines of communication should already be established between the laboratory and clinical departments. UM teams need to engage clinicians through these established communication lines as well as get to know new members of the medical staff as soon as possible after their arrival. Department chairs, nurse educators, and physicians who are new to the medical staff may bring new and innovative ideas that will benefit your UM projects. For example, if you wish to change a coagulation panel, one of the first things to do is consult a hematologist. Find someone who is willing to champion your idea to his/her colleagues. The UM team does not need to convince every clinician of the need for a change; only primary users of the test need to endorse it; the rest will follow.
The UM team should present data and arguments to clinician groups in a neutral way, using evidence-based practice (EBP) as the driver. If this approach is used, practice groups are more likely to accept the UM team's recommendations.
