Optimal Utilization of Laboratory Testing

Assumptions to Forego

November 2011

Here are some assumptions to forego. A lot of us think that doctors are comfortable ordering most tests and this is actually not true. The number of tests is exploding—no one can be proficient in all areas. Believe me, I do this every single day and I have to look up tests every single day. There are thousands and thousands of tests. Secondly, is that experienced physicians need less help in ordering and interpreting tests compared to younger colleagues. This also is not true. All physicians have gaps in their knowledge. The gaps are growing because of the number and the complexity of the tests. And finally, some think that physicians will get upset it you offer help but this actually isn’t true either. If approached as a respected colleague, most physicians welcome your help.

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Jump to section:

• Introduction
• Objectives
• Assumptions to Forego
• Roger's Adopter Categories Based on Degree of Innovativeness¹
• Changes to Manual Requisitions^2,7
• Is This Test Misused?
• Overused/Misused Tests: Good Literature Support
• Bleeding Time³
• Anti–Single–Stranded DNA: Another Misused Test^4,5,6
• Use of Algorithms
• Laboratory Test Utilization
• Thyroid Testing Guidelines
• Thyroid Function Ordering Algorithm
• Pernicious Anemia Testing Guidelines
• Pernicious Anemia Testing Cascade
• Diarrhea Work Up Guidelines
• Parasitic Investigation of Stool Specimens Algorithm
• Obsolete Tests: Laboratory Directors' Opinions⁷
• Overused/Misused Tests — Opinion
• Frequency of Testing
• Newer Tests and Panels on the Horizon
• Hints on Improving Lab Utilization
• Hints on Improving Lab Utilization (2)
• Interventions to Improve Lab Utilization⁷
• Algorithm for Assessing Send–out Tests
• Improved Test Utilization: Assistance from Clinical Practice Committee
• Other Benefits of Clinical Practice Committee
• Summary
• References
• I Welcome Your Questions
• Questions?