Demand management of weekend haematology and clinical biochemistry requests

Abstract

Summary Background Increasing demand for laboratory testing at weekends is common but little is known about its appropriateness. Methods An audit was conducted in a large district hospital of routine haematology and clinical biochemistry requests ordered over two weekends. Appropriateness was assessed by review of ordered tests compared with clinical records by a qualified chemical pathologist. Results Profiles requested on phlebotomy included full blood count (76%), renal profile (91%), C‐reactive protein (41%), liver function tests (18%) and another test in 18%. Phlebotomy was likely unnecessary in 47.5% of episodes while 60.8% of requested assays were graded probably unnecessary or unnecessary. At ward level the number of requests averaged 37 (median 32; range 2–76) totalling 446 separate profiles or assays. There was no difference in phlebotomy requests by ward (P = 0.19). Differences were observed in ordered tests (P = 0.005) which were caused by one outlier ward with a low request rate. Conclusions A large number of unnecessary common tests seem to be carried out at weekends as part of the routine care. Implementation of demand management through education and if necessary electronic limitation of requests may be useful to control laboratory workloads.

Clinical utility and economic burden of routine serum lipase determination in the Emergency Department

“…An audit conducted by the Biochemistry and Surgery Departments at North Bristol NHS Trust uncovered that at least 28% of ordered serum lipase tests were without indication . A recent study by Reynolds and Wierzbicki pointed out that a significant amount of tests requested out of hours were unnecessary …”

“…9 A recent study by Reynolds and Wierzbicki pointed out that a significant amount of tests requested out of hours were unnecessary. 10 Acute pancreatitis is an inflammatory condition of the pan- (Figures 1 and 2). 11,12 Measuring serum lipase in all patients with abdominal pain or its inclusion as part of a "diagnostic laboratory metabolic profile" for abdominal pain should therefore be discouraged because of its significant cost implications.…”

Primum non nocere: Demand management in pathology and preventing harm

“…This begs the question of how many of these monitoring tests are really necessary? In this issue of IJCP the authors describe an audit of weekend haematology and biochemistry requesting on resident in‐patients in a 500 bed district hospital . After specialist review it was clear that 50% of the tests requested were unnecessary.…”

“…In this issue of IJCP the authors describe an audit of weekend haematology and biochemistry requesting on resident inpatients in a 500 bed district hospital. 22 After specialist review it was clear that 50% of the tests requested were unnecessary. Data from the last 40 years show a similar pattern 23 and so do other current studies 24,25 indicating that the concept of phlebotomy seems not to be viewed as an invasive procedure by many medical and nursing staff.…”

Testing, testing. 1, 2, 3. Is this mic on?

“…This issue of the International Journal of Clinical Practice includes 4 articles regarding testing in medicine. Our Associate Editor for Cardiovascular Disease Prevention and Metabolic Diseases, Anthony Wierzbicki, together with Timothy Reynolds, start us off with a thoughtful extended editorial/perspective with the title (translated) “first, do no harm.” This is followed by 3 articles that describe demand management and weekend laboratory testing requests at a general hospital in the UK, the experience of a Swiss teaching hospital network in reducing unnecessary testing, and an Australian study of the variation in investigations done for adults presenting to emergency departments with chest pain . Testing is an international problem, and although the three articles in this issue of the journal are from the “first world” it would be of interest to know more about testing in medicine is countries where resources may be more limited.…”