To test or to not test: A retrospective cross-sectional study on potentially inappropriate use of pathology testing in South Australian hospitals

• Published in: American journal of clinical pathology 2024-04, Vol.161 (4), p.342-348
• Main Authors: Banker, Twisha R, Gillam, Marianne H, O’Loughlin, Peter, Rankin, Wayne, Ryan, Richard, Caruso, Connie, Roughead, Elizabeth E
• Format: Article
• Language: English
• Subjects: Aged; Australia; Biomarkers; Brain natriuretic peptide; C-reactive protein; C-Reactive Protein - analysis; Cross-Sectional Studies; Ferritin; Ferritins; Hospitals; Humans; Iron; Iron - metabolism; Lipids; National Health Programs; Natriuretic Peptide, Brain - metabolism; Original; Pathology; Peptide Fragments; Retrospective Studies; South Australia; Vitamin D
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqad153

Abstract Objectives To measure rates of potentially inappropriate pathology testing in the hospital setting. Methods Retrospective cross-sectional study in hospital setting from July 2021 to December 2021. We examined 3 potentially inappropriate uses: overordering, selection errors, and unnecessary repeat testing. Overordering included vitamin D and lipids (rarely required in acute hospital care). Selection error was the ratio of iron studies to standalone ferritin requests. Unnecessary repeats included any repeat vitamin D, lipids, iron, or ferritin in an episode of care or C-reactive protein (CRP) repeated within 3 days and N-terminal pro–brain natriuretic peptide (NT-proBNP) within 7 days and repeated previously abnormal CRP and NT-proBNP tests. Costs of inappropriate tests were estimated using the Australian Medicare Benefits Schedules. Results Among 55,904 test requests, 15% (n = 8120) were potentially inappropriate. Vitamin D was frequently ordered (n = 4498), as were lipids (n = 2872). Ratio of iron studies to standalone ferritin was 36. Of 19,233 repeat CRPs, 36% (n = 6947) were within 3 days and 62% (n = 179) of repeat NT-proBNPs were within 7 days of the first test. For initially abnormal tests, 89% of CRPs and 97% of NT-proBNPs remained abnormal. Inappropriate test costs accounted for 12% to 30% of costs. Conclusions Frequent potential inappropriate use and selection of pathology tests was observed in South Australian hospitals.