Impact of Add-On Laboratory Tests on the Clinical Laboratory. (21st September 2018)

• Record Type: Journal Article
• Authors: Xu, Kemin; Razzano, Dana; Baghian, Ani; Adem, Patricia
• Is Part Of: American journal of clinical pathology. Volume 150(2018)Supplement 1
• Page Start: S72
• Page End: S73
• Publication Date: 2018-09-21
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqy093.177
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Objectives: Add-on laboratory tests are additional assays that are ordered to be performed on previously analyzed specimens. The main challenge is that it involves retrieving original specimens for further testing, which adds substantial manual effort from clinical laboratory staff. Methods: All add-on test requests from August 30, 2017, to September 10, 2017, were retrospectively collected from clinical laboratory, then sorted by the unit/floor and category of tests. Results: The add-on test at Westchester Medical Center (5.2%) was significantly higher than that at other large academic medical centers, such as Massachusetts General Hospital (0.7%), Brigham and Women's Hospital (1.5%), University of Iowa Hospital and Clinics (0.9%), and National University Hospital in Singapore (3.2%). The majority of add-on tests were from the inpatient units, accounting for 78% of total, consistent with other academic medical centers. The most frequent add-on tests were cardiac enzymes, including CK-MB, CK or troponin I, which are presumably ordered to determine the likelihood of an acute coronary syndrome. The add-on test for cardiac enzymes was requested individually, in different combinations of the three components and rarely all three enzyme tests, suggesting it was due to CPOE error. The second most frequently requested add-on test was serum magnesium/phosphorus levels, which is not included in the basic metabolic profile (BMP), suggesting a similar CPOE error. There was no identifiable individual trend for excess number of add-on tests requested, suggesting this may be a widespread problem in the clinical setting. Conclusion: Most add-on tests could be eliminated by educating physicians and addressing any identifiable gaps in existing order sets. Therefore, physician education efforts targeting the medical teams that are responsible for the majority of add-on tests may be beneficial in reducing the number of add-on tests.