Previsit Lab Testing: A Simple Step Towards Streamlining

Photo credit: Sam Dennis

At a recent conference I attended, Christine Sinsky, MD, Vice President of Professional Satisfaction at the American Medical Association, presented data on various time savers that physician practices have tested to streamline clinical processes.

One example she described was pre-visit lab testing. She asserted that the strategy saves time and money. It sounded intriguing. I’ve seen how cluttered processes and time-consuming workarounds can really make you frazzled and sap the joy out of patient care.

As I listened to her presentation, I found myself wondering, “How does it actually work? Does it involve additional needle sticks? How do they get labs done fast enough for the results to be ready at exam time? Do they hold tubes of blood for add-on orders?”

---

Apparently, I’m not the only one with questions. In a guest post on the social media site KevinMD, a physician who became a proponent of the strategy, shared his initial concerns about extra time and the need for additional lab work during the visit.

So I did a bit of digging.

Here’s what I learned about previsit lab testing:

• Previsit lab testing is often a component of previsit planning. The larger process also includes scheduling future appointments, gathering the information for upcoming visits, and making time prior to the appointment to discuss the patient’s needs with other members of the care team, such as nurses or medical assistants.
• There are several different strategies for executing previsit lab testing. Some practices have access to rapid lab testing and ask patients to come on the day of the appointment for the blood draw. Others pre-order the labs and ask patients to go to the lab site a few days before their appointment.
• Previsit labs can reduce the total amount of work to be done. For example, providing results during an appointment eliminates phone calls, letters, or notes via a patient portal explaining results. Previsit labs support better coordination of care, because the clinician can discuss the results—and the clinical implications such as the need to increase a medication dose—face-to-face. One study found the process reduced follow up calls, cost (by about $25 per patient), and actually reduced the number of tests conducted.  
• Clinicians seem to like the new process. As one stated in a published article on best practices in primary care settings, “I can’t imagine going back to the day when I used to send out letters to patients with results of HbA1c and lipid profiles and not use those results as an opportunity for motivational interviewing, goal setting and developing an action plan.”

Previsit labs are a simple way to streamline a process that is often chaotic and inefficient for clinicians and patients. It’s akin to packing your kids’ lunches the night before instead of during the press of the morning routine—it requires initiative and more upfront work but saves hassle and headaches in the long run. For more information on implementing previsit lab testing, see the AMA’s Steps Forward modules.