Application of hepatitis serology testing algorithms to assess inappropriate laboratory utilization

Abstract

Our study provides information for inappropriate laboratory utilization for hepatitis serology testing and we suggest to use diagnostic algorithms applied by the serology laboratory to decrease the rate of unhelpful test orders.

Inappropriate Use of Serological Tests for Hepatitis B Virus in Evliya Celebi Education and Research Hospital of Dumlupinar University, Kutahya

“…Zira çalışmamızda, gereksiz anti-HBs istemleri, aynı gün yapılan test tekrarları kategorisine dahil edilmiştir. Benzer çalışmalarda gereksiz test istemlerinin değerlendirilme kriterleri birbirlerinden farklı olup, bu nedenle uygunsuz serolojik testlerin oranı da birbiriyle uyumsuzdur 7,8,[11][12][13] . Aynı gün yapılan test tekrarlarının servislerde daha fazla olmasının nedeninin; hasta servise yatmadan önce poliklinikte istenen testlerin sonuçlarının serviste HBYS'den takip edilmemesi olabileceğini düşünmekteyiz.…”

“…HBV enfeksiyonunda kullanılan testler için oldukça fazla miktarda para, iş gücü ve zaman harcanmaktadır. Özellikle de hastanın tanı ve tedavisinde faydası olmayan istemler nedeniyle yapılan birçok serolojik test; fazla iş yüküne, zaman kaybına ve yüksek maliyete sebep olmaktadır 7,8 . Bu retrospektif çalışmada HBV enfeksiyonu serolojisinde uygunsuz test istemlerinin sayısı ve oluşturduğu mali yükün belirlenmesi, ayrıca gereksiz test istemlerinin nedenlerinin ve çözüm yollarının tartışılması amaçlanmıştır.…”

Laboratory Medicine Quality Indicators

“…The first measures test order appropriateness, and the second measures inappropriateness: (1) Percentage of laboratory test orders that meet specific testing guidelines 18,19 : A list of quality measures has been compiled by the AHRQ in its NQMC database; many involve laboratory tests recommended for specific diseases and conditions (see zTable 2z for a selected list). 8 Unlike this measure, which is based on laboratory test orders, the denominators for most of the measures in Table 2 are population-based, and they target not only improving health care quality but also public health.…”

Inappropriate requests of viral hepatitis serologic tests

“…Because, the specific diagnosis of the causative agent of viral load depends primarily on serological tests, it may be suggested that the serology laboratory should apply the relevant algorithm to detect the agent responsible for viral hepatitis to assess the immune status of patients. 7,19 But, introducing algorithms for the diagnosis of viral hepatitis, especially when applied by the serology laboratory, may lead to some problems. The primary responsibility of the patients belong to their physicians, and adding or cancelling of diagnostic tests not included in the requisition forms, as the algorithm requires, might cause problems in charging as well as issues regarding malpractice.…”

“…Physician ordering practices have been analysis extensively, inappropriate test ordering, total physician visits found to be the reason for increased laboratory use. 3,[5][6][7][8] Over ordering may be the result of inexperience or lack of knowledge about the appropriate use of tests, failure to check previous results, test ordering routines that are difficult to change or fear of errors of omission and litigation. Moreover pa- Hepatitis serology is a suitable test group for application of diagnostic algorithms, as the combination of test results makes it possible to determine the causative viral agent and the stage of infection.…”