Abstract
Introduction
Beginning in 2012, the Choosing Wisely campaign sought to identify tests or procedures whose necessity should be questioned to ensure that they are truly necessary. This study aims to look at the inappropriate usage of relatively uncommon “send-out” laboratory tests that, although rare for the majority of patients, carry a much higher financial cost than more common “in-house” tests. The study objective is to gain an understanding of the fiscal impact of pathology approval of send-out test orders.
Methods
The laboratory records of send-out tests that were either approved or cancelled by the pathology department based on explicit test specific criteria were reviewed from 2004 to May 8, 2018. This review totaled 49,935 unique patients, 115,484 unique accessions for a send-out test order, and 588 unique send-out tests that did not meet criteria encompassing a menu of 725 send-out tests. The cost of each send-out test, number of cancelled tests, and number of approved tests were examined to reveal which cancelled test orders accounted for the most savings.
Conclusion
This study showed that, with no policy in place for pathology approval of send-out testing, inappropriate test orders may contribute to 30% of the cost of all send-out testing. The three areas of testing that contributed to the costliest amount of inappropriate ordering (41% of overall savings) were cytogenetics, FISH, and HIV/HCV treatment susceptibility testing. This information may be used to address the root cause of the issue by educating clinicians as to the appropriate clinical indications of certain send-out tests, the tests most commonly inappropriately ordered, and the tests that require the greatest discretion when ordering. Further study is necessary to address possible interventions that may resolve the root cause of inappropriate send-out test orders.
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