Appropriate laboratory utilization in diagnosing pulmonary embolism

Abstract

(1295) concerning studied patients were analysed. About 70.4% (93/132) of d-dimer tests were ordered in ED. In the studied patients, unfractionated heparin was administered in 17.8% (20/112) of the cases, low-molecular weight heparin in 79.5% (89/112) and heparin therapy was not administered in 2.7% (three of 112). Conclusion: This study uses a method to assess the quality of laboratory test orders using results as a tool to estimate the impact of economic resources devolved in executing inappropriate tests.

The Landscape of Inappropriate Laboratory Testing: A 15-Year Meta-Analysis

“…Thirty-eight studies investigated overutilization [15] , [17] – [20] , [22] , [23] , [25] , [26] , [28] , [36] – [63] ; eight investigated underutilization [25] , [45] , [48] , [57] , [64] – [67] ; four investigated both [25] , [45] , [48] [57] . Thirty-one studies used objective criteria for measuring appropriateness [17] , [18] [22] , [23] , [26] , [28] , [37] , [38] , [40] – [45] , [47] – [49] , [52] , [54] – [59] , [61] – [67] while 11 used subjective criteria [15] , [19] , [20] , [25] , [36] , [39] , [46] , [50] , [51] , [53] [60] . Twenty studies investigated more than one test.…”

“…sodium, glucose) [18] , [22] , [23] , [25] , [28] , [39] , [50] , [57] , [60] , [62] and complete blood count (hemoglobin, white blood cell count) [18] , [22] , [25] , [39] , [50] , [57] , [60] ; common disease monitoring tests (cholesterol, hemoglobin A1c) [45] , [50] ; tests of cardiac (creatine kinase) [18] , [50] , liver (transaminases, alkaline phosphatase) [18] , [23] , [25] , [39] , [50] , [54] , [62] , [63] , [65] , thyroid (thyroxine, thyroid stimulating hormone) [64] , and kidney function (blood urea nitrogen, creatinine) [18] , [22] , [23] , [25] , [39] , [50] , [57] , [60] , [62] , tests for anemia (iron, ferritin, B12, serum folate) [39] , [40] , coagulopathy (prothrombin time, partial thromboplastin time [PTT], protein C, protein S, D-dimer) [18] , [39] , [42] , [50] , [55] , [57] , ...…”

Utilisation of sFLC assays – how well do we comply with guidelines?

“…Over‐requesting of pathology tests is common in clinical practice with substantial associated economic costs . Studies in South Australian and Victorian hospitals, for example, found that 61% and 58% of tumour marker requesting is performed within hospital guidelines, respectively .…”

“…Previous pathology requesting patterns have been shown to depend on; (i) request form layout , (ii) clinician experience , (iii) communication between laboratory and clinic , (iv) referral base and (v) hospital policies . While anecdotal evidence suggests that over‐requesting may extend to the tests for detecting and monitoring M proteins in PCDs, to our knowledge, this is the first study analysing sFLC assay requesting patterns . In our study, we assessed use of the sFLC assay, adherence to guidelines published by the IMWG and likely causes of non‐adherence.…”

“…monitoring requests for the 267 patients with MM, SMM, MGUS, AL amyloidosis and solitary plasmacytoma in this period (Figure 1). This equated to 4.3 assays on average per patient (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Overall, 56 clinicians requested these assays with most assays being for MM patients (844, 73%), followed by MGUS (188, 16%), AL amyloidosis (72, 6%) and SMM (46, 4%).…”