Are laboratory tests always needed? Frequency and causes of laboratory overuse in a hospital setting

Cadamuro, Janne; Gaksch, Martin; Wiedemann, Helmut; Lippi, Giuseppe; Meyer, Alexander; Pertersmann, Astrid; Auer, Simon; Mrazek, Cornelia; Kipman, Ulrike; Felder, Thomas K.; Oberkofler, Hannes; Haschke-Becher, Elisabeth

doi:10.1016/j.clinbiochem.2018.01.024

Cited by 50 publications

(37 citation statements)

References 29 publications

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“…The most obvious reason may be the advancement in technology, assay repertoire and improved turn-around time (TAT), thus making test ordering and receiving results very easy, quick and comfortable. As availability is creating demand, an electronic order-entry (OE) system may lead to increased test ordering, especially when using the so-called laboratory ordering profiles/panels [7].…”

Section: What Are the Reasons For Inappropriate Testing?mentioning

confidence: 99%

“…When asked, every laboratory specialist and most ordering physicians will most probably be able to identify superfluous tests or orders for general or specific medical conditions. In a previous study we surveyed clinicians and nurses with the aim of acknowledging what they felt was the leading reason for excessive testing [7]. Laboratory ordering profiles and tests being obsolete because of another analysis result on the same laboratory report were two of the main reasons.…”

Section: How Do We Identify Inappropriate Use Of Laboratory Testing? mentioning

confidence: 99%

“…However, it is highly questionable if every single test ordered is indeed used (or required) for the clinical decision making. In a recent study, we estimated that 60-70% of high throughput laboratory tests in clinical chemistry and coagulation are potentially inappropriate, or of minor clinical relevance [7]. Other authors reported inappropriateness ranging between 5% and 95% of tests, depending on the criteria used for establishing appropriateness [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Managing inappropriate utilization of laboratory resources

et al. 2018

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Background The inappropriate use of laboratory resources, due to excessive number of tests not really necessary for patient care or by failure to order the appropriate diagnostic test, may lead to wrong, missed or delayed diagnosis, thus potentially jeopardizing patient safety. It is estimated that 5-95% of tests are currently used inappropriately, depending on the appropriateness criteria, thus significantly contributing to the potential of generating medical errors, the third leading cause of death in the US. Content In this review, we discuss the reasons as well as the medical and financial consequences of inappropriate utilization of laboratory tests. We then provide demand management (DM) tools as a means for overcoming this issue and also discuss their benefits, challenges, limitations and requirements for successful implementation. Summary and outlook When based on current evidence, adapted to local conditions and developed in close collaboration with clinicians, DM is a reasonable strategy for progressing toward better management of over- and underuse of laboratory resources.

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Section: What Are the Reasons For Inappropriate Testing?mentioning

confidence: 99%

Section: How Do We Identify Inappropriate Use Of Laboratory Testing? mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Managing inappropriate utilization of laboratory resources

et al. 2018

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“…Junior hospitals doctors have been reported to order more avoidable tests than their senior colleagues and to order the same routine set of tests for all patients regardless of individual presentations . Thus, they might also be more likely to frequently rely on potentially flawed routine order sets in the electronic medical records (EMR) when ordering tests in ED . In contrast to junior doctors, the nursing scope of practice or standing order protocols formally restrict nurses in what they can order on their own volition.…”

Section: Discussionmentioning

confidence: 99%

“…20,24 Thus, they might also be more likely to frequently rely on potentially flawed routine order sets in the electronic medical records (EMR) when ordering tests in ED. 25 In contrast to junior doctors, the nursing scope of practice or standing order protocols formally restrict nurses in what they can order on their own volition.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of variation in pathology investigations and associated factors for adult patients presenting to emergency departments with chest pain: An observational study

Wabe

Dahm

et al. 2018

Int J Clin Pract

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SUMMARY Objective To determine variation in pathology test ordering practices and identify associated factors for adult patients presenting to emergency departments (ED) with chest pain and subsequently admitted with ischaemic heart disease. Methods A retrospective study across six hospital EDs in New South Wales, Australia. A total of 6769 patient presentations between January 2014 and December 2017 met the inclusion criteria. Ordered pathology tests were grouped into three categories based on Australasian College for Emergency Medicine and the Royal College of Pathologists of Australasia recommendations: category I (no restriction in ordering), category II (can be ordered after consulting a supervisor) and category III (not for routine ordering in ED). The primary outcome was the proportion of category III test ordering across study EDs. Factors associated with category III test ordering were identified using a logistic regression. Results A total of 34 936 pathology tests were ordered: 65.6% (n = 22 932) were category I/II tests and 34.4% (n = 12 004) were category III tests. Five tests (Calcium Magnesium Phosphate, Coagulation Studies, Lipase, C‐reactive Protein and Blood Gas tests) accounted for 84.7% of all category III tests. The proportion of category III tests ordered varied by hospitals from 29.8% to 45.9%. The proportion of patients with at least one category III test was 76.3% (range across hospitals: 68.3%‐95.6%). Increasing age, presentation to an ED at night, and those in an imminently life‐threatening triage category were significantly associated with increased likelihood of category III test ordering. The proportion of category III tests decreased over time. EDs in medium and/or regional hospitals were more likely to order a category III test. Conclusion Pathology investigations for patients presenting with chest pain varied significantly across EDs suggesting opportunities to improve standardisation of test ordering practices.

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Laboratory Identification of Bacterial Infections

Janda¹

2022

Encyclopedia of Infection and Immunity

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Are laboratory tests always needed? Frequency and causes of laboratory overuse in a hospital setting

Cited by 50 publications

References 29 publications

Managing inappropriate utilization of laboratory resources

Managing inappropriate utilization of laboratory resources

An evaluation of variation in pathology investigations and associated factors for adult patients presenting to emergency departments with chest pain: An observational study

Laboratory Identification of Bacterial Infections

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