The risks of defensive (emergency) medicine. The laboratory perspective

Montagnana, Martina; Lippi, Giuseppe

doi:10.4081/ecj.2016.5581

Cited by 3 publications

(4 citation statements)

References 33 publications

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“…This is noticeably confirmed by recent data attesting that up to 70% of the clinical decisions are substantially based on results of diagnostic tests (1). Laboratory tests ordering is a multidimensional enterprise, primarily driven by tests availability, physicians' education, skill, habits, liability and legal protection (i.e., defensive medicine) (2).…”

Section: Introductionmentioning

confidence: 83%

Inappropriateness in laboratory medicine: an elephant in the room?

2017

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Appropriateness of diagnostic testing can be conventionally described as prescription of the right test, using the right method, at the right time, to the right patient, with the right costs and for producing the right outcome. There is ongoing debate about the real burden of inappropriateness in laboratory diagnostics. The media coverage of this issue has also recently led to either over-or under-emphasizing the clinical, organizational and economic consequences. This is quite problematic, inasmuch as some reliable data are available in the current scientific literature, showing that inappropriateness of laboratory testing can be as high as 70%. This is especially evident for, though not limited to, cancer biomarkers testing, in which the practice of avoidable tests ordering is dramatically magnified. The reasons beyond inappropriateness are many and multifaceted, entailing wrong habits, resistance to changes, poor culture, insufficient education and healthcare inefficiencies. There are many unfavorable consequences attributable to avoidable testing, including unjustified incremental costs, derangement of laboratory efficiency and potential patient safety issues. The tentative solutions to this important problem necessitate that policymakers, local hospital administrators, laboratory professionals, clinicians, patients' associations and diagnostic companies join the efforts and embark in the same landmark effort for disseminating a better culture of appropriateness.

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Section: Introductionmentioning

confidence: 83%

Inappropriateness in laboratory medicine: an elephant in the room?

2017

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“…When asked In which diagnostic issues do you more frequently seek consultation with laboratory colleagues in test interpretation?, 88 responders (48.1%), replied I never seek consultation with laboratory colleagues. Among those who occasionally seek consultation with laboratory colleagues, the most frequent field was hematology (35), followed by diagnostics of acute myocardial infarction (22) and coagulation disorders (20). When asked How could you describe your feedback from lab colleagues when you ask an expert opinion, the vast majority of responders replied that they find it useful (69: Almost always useful; 44: Sometimes useful).…”

Section: Resultsmentioning

confidence: 99%

“…Defensive medicine is undoubtedly one of such issues, since the emergency settings are particularly plagued by malpractice and liability, 21 thus leading the way to an inappropriate utilization of laboratory resources. 22 This unjustified practice carries several risks, such as the possible generation of false positive results, the disruption of laboratory organization and ultimate waste of human and economic healthcare resources. 12 Previous evidence emphasized that the pattern of urgent test requesting in emergency settings is highly variable, 13 thus underscoring the need to achieve widespread consensus for harmonizing requesting attitudes.…”

Section: Discussionmentioning

confidence: 99%

Attitudes and beliefs of emergency physicians on lab tests utilization in clinical practice. A multicenter survey

Saccenti¹,

Lunian²,

Montagnana

et al. 2019

Emerg Care J

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It is commonly perceived that the main obstacle for an effective partnership between Emergency Medicine (EM) and Laboratory Medicine (LM) is the lack of reciprocal knowledge and understanding. A further aspect is a partial comprehension of clinical significance and implications of some tests. The real scenario of attitudes and beliefs of Emergency Physicians (EPs) on lab tests utilization in clinical practice remains largely unclear. Therefore, this original study was designed to explore this field of medical knowledge, by using a survey on attitudes and beliefs in laboratory diagnostics which was disseminated among many Italian EPs. A questionnaire containing 20 different items/statements was designed and then disseminated either directly, or in a digital format. Overall, 183 questionnaires were compiled and collected. The results of this nationwide survey seem to confirm the existence of a suboptimal knowledge of both clinical and economic impact of urgent laboratory tests by Italian EPs. An unsatisfactory relationship between EPs and laboratory professionals seems also to emerge. Several EPs attribute this to Shortage of time to think (18.6%), followed by Fair of medical-legal litigation (13.6%). On the other hand, interestingly, it also emerged that some Italian hospitals still include obsolete o redundant tests in panels of urgent laboratory analyses, potentially misleading for the diagnostic reasoning in the Emergency Department (ED). In conclusion, the virtuous circle between EM and LM should be further reinforced for optimizing clinical pathways in Italian EDs, improving clinical outcomes and reducing unnecessary expenditures. A major agreement between laboratory and emergency professionals

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“…The emergency settings are especially vulnerable to malpractice and liability, 13 thus predisposing to inappropriate usage or overuse of laboratory resources. 14 This inappropriate and unwarranted practice has many inherent drawbacks, such as the enhanced risk of generating false positive results, disrupting laboratory workflow, increasing complexity in information management, prolonging the turnaround time and wasting both human and economic healthcare resources. On the other hand, inappropriateness also encompasses underuse of otherwise necessary or useful tests and, even in such case, the clinical consequence of a missed or delayed diagnosis can be detrimental.…”

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confidence: 99%