Curbing Unnecessary Lab Tests

Ordering the wrong test can lead to an unnecessary phlebotomy, create health complications for the patient, and drive up costs. Gary W. Procop, MD, medical director for enterprise test utilization with the Cleveland Clinic, will be offering some tools to avoid these situations on Sept. 16 at AACC’s Lab Solutions Summit.

During his presentation, “Curbing Inappropriate Testing in Your Organization: Solutions That Work,” Procop will discuss at least five major initiatives the Cleveland Clinic has undertaken to curb unnecessary test utilization:

1. The “hard stop initiative,” which aims to stop same-day duplicate test orders on hospitalized patients.
2. Laboratory-based genetic counselor triage, which involves certified medical professionals reviewing a test order and then looking at the patient’s medical record to see whether it is appropriate for the patient to receive the test in question. If it doesn’t seem so, or if the doctor involved doesn’t ordinarily order genetic tests, the genetic counselor contacts the doctor and advises him or her on testing options, Procop told CLN Stat. Not only does this curb unnecessary testing, it can help direct a physician to order the right test.
3. The “restricted use initiative,” which aims to curb misordering by limiting the ability to order certain tests to certain groups of physicians. These are predominantly expensive, molecular genetic tests that are most efficiently used by subspecialists.
4. The “expensive test alert,” which notifies the provider that he or she is about to order a test that costs more than a certain dollar amount.
5. The “regional smart alert,” or same-day duplicate test initiative for Cleveland Clinic’s regional hospitals. Procop admits that this approach hasn’t been as successful as the hard stop initiative used on the main campus.

These strategies have reduced costs, while not alienating physicians and other healthcare providers. Additionally, Cleveland Clinic expects these best practices to improve patient care and patient satisfaction.

Laboratories exist in an age where clinical decision support tools embedded in electronic medical records enable real-time interaction with providers who are using computerized physician order entry. “At the moment of order entry, we can notify the provider about the cost of a test if it is very high, or if a test is redundant or even inappropriate for that patient,” Procop explained to CLN Stat. This decreases the chance of a patient getting a phlebotomy that he or she didn’t need.

Unnecessary phlebotomy can lead to health consequences for the patient, Procop emphasized. Hospitalized patients in particular can develop iatrogenic anemia and have poorer wound healing and higher infection rates. “So, it’s important not to over-phlebotomize patients,” he said.

Register online to attend this session at AACC’s Lab Solutions Summit. This virtual program features an expert faculty, interactive poster sessions, and vendor exhibits and is worth 11.5 ACCENT continuing education credits.