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

Inappropriate utilization of laboratory resources is an increasing concern especially in high-throughput facilities. Until now, no reliable information has been published addressing to which extent laboratory results are actually used for clinical decision-making. Therefore, we aimed to close this g...

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Bibliographic Details
Published in:Clinical biochemistry 2018-04, Vol.54, p.85-91
Main Authors: Cadamuro, Janne, Gaksch, Martin, Wiedemann, Helmut, Lippi, Giuseppe, von Meyer, Alexander, Pertersmann, Astrid, Auer, Simon, Mrazek, Cornelia, Kipman, Ulrike, Felder, Thomas K., Oberkofler, Hannes, Haschke-Becher, Elisabeth
Format: Article
Language:English
Subjects:
Inappropriateness of laboratory utilization
Overutilization
Postanalytics
Preanalytics
Routine diagnostics
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Summary:Inappropriate utilization of laboratory resources is an increasing concern especially in high-throughput facilities. Until now, no reliable information has been published addressing to which extent laboratory results are actually used for clinical decision-making. Therefore, we aimed to close this gap using a novel retrospective approach including a survey of clinicians and nurses. We retrospectively evaluated the number of re-orders for potassium (K), lactate dehydrogenase (LD), aspartate-aminotransferase (AST), activated partial thromboplastin-time (APTT) and prothrombin-time/INR (PT/INR), after the initial order had to be cancelled due to preanalytical non-conformities. We analyzed subgroups regarding time to re-order, ward and sample priority (urgent vs. routine). Subsequently, we surveyed clinicians and nurses, asking for their estimate of the amount of failed re-orders as well as for possible reasons. From initially cancelled tests, only ~20% of K, LD, AST and ~30% of APTT and PT/INR tests were re-ordered within 24 h. 70% of the investigated clinical chemistry and 60% of coagulation tests were re-ordered one week after cancellation or not at all. Survey participants quite accurately estimated these numbers. Routine laboratory panels, short stay of out-patients, obsolete test results and avoiding additional phlebotomies were the main reasons for not re-ordering cancelled tests. Overall, 60–70% of test results in the investigated assays ordered in a high throughput laboratory are potentially inappropriate or of doubtful clinically importance. Although clinicians and nurses are aware of this situation, it is the duty of laboratory specialists to overcome overutilization in close collaboration with all involved healthcare workers. •We show that 60–70% of laboratory tests may be potentially inappropriate.•Clinicians and nurses seem to be aware of this situation.•Reasons herefore are manifold, including laboratory ordering profiles.•Laboratory specialists need to address this issue.
ISSN:0009-9120
1873-2933
DOI:10.1016/j.clinbiochem.2018.01.024