Inappropriate repeat testing of complete blood count (CBC) and electrolyte panels in inpatients from Alberta,Canada |
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| Affiliation: | 1. Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;2. Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;3. Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;4. Alberta Public Laboratories (formerly Calgary Laboratory Services), Calgary, Alberta, Canada;1. Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria;2. Department of Medical Laboratory Diagnostics, University Hospital Sveti Duh, Zagreb, Croatia;3. Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia;4. Clinical Laboratory, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain;5. Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien, Weiden and Amberg, Germany;6. Biochemistry Department, Worcester Acute Hospitals NHS Trust, Worcester, UK;7. Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Spain;8. Dept. of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark;9. Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy;1. Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Canada;2. Family Medicine, Cumming School of Medicine, University of Calgary, Canada;3. Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada;4. Alberta Public Laboratories, Calgary, Alberta, Canada;1. Department of Medicine, Massachusetts General Hospital, Boston;2. Harvard Medical School, Boston, Mass;3. Division of Infectious Diseases, Massachusetts General Hospital, Boston;4. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston;5. Biostatistics Center, Massachusetts General Hospital, Boston;6. Georgia Regents University/Medical College of Georgia, Augusta;7. Department of Pathology, Massachusetts General Hospital, Boston;8. Emory University School of Medicine, Atlanta, Ga |
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| Abstract: | IntroductionThe avoidance of repeat chemistry testing such as Complete Blood Count (CBC) and Electrolyte Panel (EP) on clinically stable patients was identified as important utilization goals by Choosing Wisely Canada. The purpose of this study was to assess the volume of overutilization of CBC and EP in an inpatient setting in Alberta, Canada, and provide an estimated cost assessment of unnecessary testing.MethodsThe total laboratory testing volumes of two common test panels were collected retrospectively for one-year from January to December 2018. Data was collected on test panels performed in an emergency room (ER) and inpatient setting from three separate Laboratory Information Systems covering the provincial population in Alberta, Canada. Total initial test panel instances, total repeated panels, repeated panels that were previously normal or abnormal, and estimated costs were examined. Cost assessment was completed based on Reference Median Cost (RMC) analysis for each of these two common test panels.ResultsDuring the study period, 2,020,467 (CBC) and 1,455,983 (EP) initial test panel instances were recorded, of which 67.7% and 73.5% were repeated for the CBC and EP, respectively. There was a higher proportion of EP repeated inappropriately (previously normal; 35.6%) compared to CBCs (5.4%). The cost to the province for inappropriately repeating CBC and EP were estimated to be RMC $0.52 million and RMC $1.90 million CAD, respectively.ConclusionResults from this study can assist policy makers in implementing utilization management initiatives and update clinical practice guidelines to reduce costs to healthcare without compromising patient care. |
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| Keywords: | Unnecessary testing Laboratory utilization Repeat testing Test cost Patient safety |
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