Uneconomic Performance of Inpatient Laboratory Investigations in National Hospital of Sri Lanka: An Evidence Based Management Approach for Cost Containment

  • U. M. G. S. Francis
  • W. M. T. Wijetunga
  • W. K. Wickremasinghe


The National Hospital of Sri Lanka (NHSL) is a 3,231 bedded hospital which is the final referral center for healthcare in the country. More than 5.8 million laboratory investigations are done annually in NHSL with a daily average reaching 16,000. This high demand for laboratory services incurs a huge cost to the hospital necessitating cost containment while maintaining quality. Analysis of annual statistics revealed that the most frequently done laboratory investigations in NHSL were Full Blood Count (FBC), C-Reactive Protein (CRP), Serum Electrolytes (SE), Serum Creatinine (S.CR), Aspartate Amino Transferase/ Alanine Amino Transferase (AST/ALT) and Troponin I. Situation analysis was done through staff interviews and desk review of bed head tickets (BHTs) in a selected medical ward and a surgical ward. Analysis of the findings revealed that performance of frequently requested inpatient laboratory investigations was uneconomic. Root cause analysis identified deficiencies in documenting investigations in BHTs, deficiencies in labeling and filling investigation forms, repetitive sample collection due to hemolysis and not using the investigation results for patient management. The case study suggests introduction of lean management concepts, improvement of documentation, conduction of clinical audits, standardization of investigation formats, introduction of standard operating procedures (SOP), staff skill development, supervision and performance review as possible cost containment strategies while assuring the quality of inpatient laboratory investigations.Key words: Uneconomic, Laboratory investigations, Cost containment, National Hospital of Sri Lanka