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Optimal Utilization of Laboratory Testing



Algorithm for Assessing Send–out Tests

Slide 25

November 2011

Here's an algorithm for assessing send-out tests which can also be a drain on your laboratory. First of all, is to start at the top, what’s the clinical question to be answered. And a lot of times, we laboratorians, we'd like to be as helpful as possible but we forget to ask the question—"Doctor, what are you trying to answer—what are you trying to rule in and rule out?" And there's two questions to ask in the situation. Ask, can you do the test, but more importantly ask, should the test be done according to clinical judgment and is a reliable, scientific sound, test even available. There are some very promising markers that are referenced, for example, in the National Association for Clinical Biochemistry through the American Association for Clinical Chemistry. There are some guidelines and they show some promising markers not yet ready for prime time. If we follow this algorithm to the right, if evidence based medicine, your literature review shows that no test is available or it’s not ready for prime time, you can offer your clinicians alternative tests available in your lab or alternate tests available in the reference lab if not urgent. If we follow down the left side of the algorithm, if evidence based medicine shows that a test is available and if it's urgent and you need a fresh specimen needed and it’s less that 24 hours turn around time and you need it available 365, 24, 7, then you have to ask yourself does your lab have the technical and operational capability to perform the test and if the answer may be no. But if it is yes, then you can consider setting up that test in house if you have the volume and you have the clinical need. And you have to ask yourself that if the test can be done depending on the technical and operational aspects. And technical you'd like to work with a lab supervisor and medical technologist if you’re a director. And operational, you would like to work with your administration regarding the operational flow, financial constraints, and the capital to purchase that instrument. And in the middle, if the evidence based medicine algorithm shows the test is available, and it’s not urgent or esoteric, then you could refer it to a reliable reference laboratory.

Algorithm for Assessing Send–out Tests
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