Avoid excess lab testing: How you can help
Lab testing volumes are increasing at an alarming rate placing pressure on an already overstretched health care system.1 Excess testing can increase health care costs and create medicolegal liability for practitioners through delayed diagnoses and treatment and missed or misinterpreted results.1
 
Drivers of increased use of laboratory testing include:
  • Inadequate understanding of test ordering and interpretation.
  • Increasing burden of disease in a rapidly aging population.
  • Complex comorbidities.
  • Patient demands.
  • Computer-based order sets.
  • Lack of knowledge regarding the financial costs of tests.
  • The ever-increasing test options available to clinicians.2-4
Here are three examples of laboratory test utilization recommendations that have been implemented in Alberta and are supported by Choosing Wisely Canada:
  1. Avoidance of repeat HbA1c testing within three months of prior results: red blood cell lifespan is 90-120 days and any change in a patient’s diet or medications are not reflected in the HbA1c until the previous RBCs are replaced.
  2. Anti-tissue transglutaminase IgA (anti-tTg IgA) is the appropriate initial screening test for Celiac disease: additional Celiac disease serology testing should not be ordered.
  3. Providing appropriate clinical history to guide ordering of allergen specific IgE testing: positive result represents sensitization and not necessarily a clinical allergy.
 References
  1. Abbott M, Paulin H, Sidhu D, Naugler C. Laboratory tests, interpretation, and use of resources: a program to introduce the basics. Can Fam Physician, 2014 Mar;60(3):e167-72.
  2. Yancik R. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer 1997;80(7):1273-83.
  3. Solomon DH, Hashimoto H, Daltroy L, Liang MH. Techniques to improve physicians’ use of diagnostic tests: a new conceptual framework. JAMA 1998;290(23):2020-7.
  4. Smellie WS. Demand management and test burdened request rationalization. Ann Clin Biochem 2012;49(Pt 4):323-36. Epub 2012 Jun 25.
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