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

Clinical Biochemistry

Volumn 54, Issue , 2018, Pages 85-91

  Cadamuro, Janne ^a   Gaksch, Martin ^a   Wiedemann, Helmut ^a   Lippi, Giuseppe ^b   von Meyer, Alexander ^c   Pertersmann, Astrid ^d   Auer, Simon ^a   Mrazek, Cornelia ^a   Kipman, Ulrike ^e   Felder, Thomas K ^a   Oberkofler, Hannes ^a   Haschke Becher, Elisabeth ^a  

^a PARACELSUS MEDICAL UNIVERSITY   (Austria)

^b UNIVERSITY OF VERONA   (Italy)

^c KLINIKUM ST MARIEN   (Germany)

^d UNIVERSITY OF GREIFSWALD   (Germany)

^e UT SPSS Statistics   (Austria)

Author keywords

Inappropriateness of laboratory utilization; Overutilization; Postanalytics; Preanalytics; Routine diagnostics

Indexed keywords

ASPARTATE AMINOTRANSFERASE; LACTATE DEHYDROGENASE; POTASSIUM;

ACTIVATED PARTIAL THROMBOPLASTIN TIME; ARTICLE; BLOOD CLOTTING TEST; FREQUENCY; HEALTH CARE PERSONNEL; HEALTH CARE SURVEY; HEALTH CARE UTILIZATION; HEALTH SERVICE; HOSPITALIZATION; HUMAN; INTERNATIONAL NORMALIZED RATIO; LABORATORY TEST; NURSE; OUTPATIENT; PATIENT CARE; PHLEBOTOMY; PRIORITY JOURNAL; PROTHROMBIN TIME; RETROSPECTIVE STUDY; BLOOD ANALYSIS; FEMALE; HOSPITAL; MALE;

BLOOD CHEMICAL ANALYSIS; FEMALE; HOSPITALS; HUMANS; MALE; MEDICAL OVERUSE; RETROSPECTIVE STUDIES;

EID: 85044501821     PISSN: 00099120     EISSN: 18732933     Source Type: Journal    
DOI: 10.1016/j.clinbiochem.2018.01.024     Document Type: Article

References (33)

1. Laposata, M.E., Laposata, M., Van Cott, E.M., Buchner, D.S., Kashalo, M.S., Dighe, A.S., Physician survey of a laboratory medicine interpretive service and evaluation of the influence of interpretations on laboratory test ordering. Arch. Pathol. Lab. Med. 128 (2004), 1424–1427.
2. Laposata, M., Putting the patient first – using the expertise of laboratory professionals to produce rapid and accurate diagnoses. Lab. Med. 45 (2014), 4–5.
3. Zhi, M., Ding, E.L., Theisen-Toupal, J., Whelan, J., Arnaout, R., The landscape of inappropriate laboratory testing: a 15-year meta-analysis. PLoS One, 8, 2013, e78962.
4. Gandhi, T.K., Kachalia, A., Thomas, E.J. et al., Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann. Intern. Med. 145 (2006), 488–496.
5. Wertheim, B.M., Aguirre, A.J., Bhattacharyya, R.P. et al., An educational and administrative intervention to promote rational laboratory test ordering on an academic general medicine service. Am. J. Med. 130 (2017), 47–53.
6. Elnenaei, M.O., Campbell, S.G., Thoni, A.J., Lou, A., Crocker, B.D., Nassar, B.A., An effective utilization management strategy by dual approach of influencing physician ordering and gate keeping. Clin. Biochem. 49 (2016), 208–212.
7. Pilsczek, F.H., Rifkin, W.D., Walerstein, S., Overuse of prothrombin and partial thromboplastin coagulation tests in medical inpatients. Heart Lung 34 (2005), 402–405.
8. Hawkins, R.C., Potentially inappropriate repeat laboratory testing in inpatients. Clin. Chem. 52 (2006), 784–785.
9. Freedman, D., Towards better test utilization – strategies to improve physician ordering and their impact on patient outcomes. JIFCC. 26 (2015), 15–30.
10. Hauser, R.G., Shirts, B.H., Do we now know what inappropriate laboratory utilization is? An expanded systematic review of laboratory clinical audits. Am. J. Clin. Pathol. 141 (2014), 774–783.
11. Rao, G.G., Crook, M., Tillyer, M.L., Pathology tests: is the time for demand management ripe at last?. J. Clin. Pathol. 56 (2003), 243–248.
12. Salinas, M., Lopez-Garrigos, M., Asencio, A. et al., Strategy to improve the request of uric acid in primary care: preliminary results and evaluation through process and outcome appropriateness indicators. Clin. Biochem. 47 (2014), 467–470.
13. World Medical A, World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310 (2013), 2191–2194.
14. van Walraven, C., Naylor, C.D., Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. JAMA 280 (1998), 550–558.
15. Fryer, A.A., Smellie, W.S.A., Managing demand for laboratory tests: a laboratory toolkit. J. Clin. Pathol. 66 (2013), 62–72.
16. Lippi, G., Mattiuzzi, C., Plebani, M., Stat testing utilization in clinical laboratories. National survey of Italian Society of Clinical Biochemistry and Molecular Biology (SIBioC). Clin. Chem. Lab. Med. 52 (2014), e79–84.
17. Smellie, W.S.A., Time to harmonise common laboratory test profiles. BMJ, 344, 2012.
18. Hoffmann, G.E., Aufenanger, J., Födinger, M. et al., Benefits and limitations of laboratory diagnostic pathways. Diagnosis 1 (2014), 269–276.
19. Price, C.P., John, A.S., Christenson, R. et al., Leveraging the real value of laboratory medicine with the value proposition. Clin. Chim. Acta 462 (2016), 183–186.
20. Plebani, M., Towards a new paradigm in laboratory medicine: the five rights. Clin. Chem. Lab. Med. 54 (2016), 1881–1891.
21. Plebani, M., Lippi, G., Is laboratory medicine a dying profession? Blessed are those who have not seen and yet have believed. Clin. Biochem. 43 (2010), 939–941.
22. Laposata, M., Patient-specific narrative interpretations of complex clinical laboratory evaluations: who is competent to provide them?. Clin. Chem. 50 (2004), 471–472.
23. Makary, M.A., Daniel, M., Medical error-the third leading cause of death in the US. BMJ, 353, 2016, i2139.
24. Slawomirski, L., Auraaen, A., Klazinga, N., The economics of patient safety - strengthening a value-based approach to reducing patient harm at national level. Organisation for Economic Co-operation and Development - OECD, March 2017 Available at: http://www.oecd-ilibrary.org/social-issues-migration-health/the-economics-of-patient-safety_5a9858cd-en. (Accessed 8 June 2017)
25. van Walraven, C., Goel, V., Chan, B., Effect of population-based interventions on laboratory utilization - a time-series analysis. JAMA 280 (1998), 2028–2033.
26. Winkens, R.A.G., Ament, A.J.H.A., Pop, P., Reniers, P.H., Grol, R.P.T.M., Knottnerus, J.A., Routine individual feedback on requests for diagnostic tests: an economic evaluation. Med. Decis. Mak. 16 (1996), 309–314.
27. Lang, T., Croal, B., National minimum retesting intervals in pathology. 2015, The Royal College of Pathologists, London Available at: https://www.rcpath.org/resourceLibrary/g147-minretestingintervalsinpathology-dec15-pdf.html. (Accessed 8 June 2017)
28. Lippi, G., Brambilla, M., Bonelli, P. et al., Effectiveness of a computerized alert system based on re-testing intervals for limiting the inappropriateness of laboratory test requests. Clin. Biochem. 48 (2015), 1174–1176.
29. Salinas, M., Lopez-Garrigos, M., Asencio, A., Leiva-Salinas, M., Lugo, J., Leiva-Salinas, C., Laboratory utilization improvement through a computer-aided algorithm developed with general practitioners. Clin. Chem. Lab. Med. 53 (2015), 1391–1397.
30. Bailey, J., Jennings, A., Parapia, L., Change of pathology request forms can reduce unwanted requests and tests. J. Clin. Pathol. 58 (2005), 853–855.
31. Barth, J.H., Balen, A.H., Jennings, A., Appropriate design of biochemistry request cards can promote the use of protocols and reduce unnecessary investigations. Ann. Clin. Biochem. 38 (2001), 714–716.
32. Cadamuro, J., Mrazek, C., Wiedemann, H. et al., Effectiveness of a laboratory gate-keeping strategy to overcome inappropriate test utilization for the diagnosis of heparin-induced thrombocytopenia. Semin. Thromb. Hemost. 43 (2017), 645–648.
33. Lippi, G., Bovo, C., Ciaccio, M., Inappropriateness in laboratory medicine: an elephant in the room?. Ann. Transl. Med., 5, 2017, 82.