Trends and patterns of laboratory utilization in a community hospital: A 10-year retrospective study for rational laboratory utilization development

Abstract

Background: Irrational use of laboratory services directly impacts hospital resources and financial management, particularly in community hospitals with limited resources. Analyzing long-term trends is a crucial first step in developing strategic policies for Rational Laboratory Utilization (RLU). Objectives: To investigate trends in laboratory testing frequency and expenditure at Khok Pho Hospital and to analyze utilization patterns over a decade (2013-2022). Materials and methods: A retrospective descriptive study using aggregate secondary data from the laboratory information system (LIS). Data were analyzed using descriptive statistics, Pareto analysis, simple linear regression for trend analysis, and the Pearson correlation coefficient to examine the relationship between the number of patients and test volume and cost. Results: Over the ten years, total laboratory test volume increased by 79.1%, rising from 125,865 tests in 2013 to 225,400 tests in 2022. Total laboratory service costs increased 2.07-fold compared with the base year. Linear regression demonstrated significant increasing trends in both test volume (β=12,083 tests/year, R²=0.829, p<0.001) and total expenditure (β=1.32 million THB/year, R²=0.918, p<0.001). After test volume peaked in 2021 due to the expansion of COVID-19 screening, volume declined in 2022 to 225,400 tests, reflecting post-pandemic normalization. Pareto analysis showed that a small number of tests accounted for most total expenditure, particularly HbA1c and lipid profile testing. The number of patients tested correlated strongly with both test volume (r=0.90) and total cost (r=0.95, both p<0.001), indicating that growth in service users was a key driver of rising laboratory costs. The proportion of off-hour workload increased from 23.5% to 26.8%. Conclusion: Laboratory utilization has grown steadily, driven by the prevalence of chronic diseases and the impact of COVID-19. These findings support implementing Rational Laboratory Utilization policies that focus on high-cost tests and optimize off-hour ordering to improve cost efficiency in community hospitals.