Page 175 - Registrar Orientation Manual 2016

Type:
Clinical Guideline
Document reference:
Manual Classification:
Service Specific Laboratory
Title:
Laboratory Testing Guidelines (DRAFT)
Effective date:
2015
Facilitator sign/date
Paul Reeve
Head of Medicine
Sponsor authorised sign/date
Stephen du Toit
CD Laboratory
Version:
01
Page:
1 of 28
Document expiry date:
2018
 Waikato DHB, August 2015 Introduction
The main aim of these guidelines for laboratory testing is to rationalise the use of laboratory tests in Waikato DHB hospitals. They have been developed primarily to reduce requests for tests that are clinically inappropriate and/or unlikely to be of benefit to the patient.
Unnecessary tests are not just a waste of resources but also can cause harm:
 A recent study of 1900 patients undergoing cardiac surgery published in the Annals of Thoracic Surgery found the average patient had 115 tests and 454 mL of blood drawn!
 Another study showed the finding of bacteriuria from doing MSUs in asymptomatic elderly patients led to inappropriate antibiotic prescribing exposing patients to side effects.
 Chasing incidental findings on unnecessary tests can cause harm to patients.
Our resources will always be limited so these guidelines are also intended to limit or ration the use of some expensive tests. By having agreed guidelines it means that the organization will take the risk if rationing limits access and leads to a complaint or poor outcome.
These guidelines have been (or will be) endorsed by the Waikato Hospital Clinical Director Forum and the Management Executive Committee. The laboratory will review requests according to them. In the future these guidelines will be used to develop rules for electronic ordering.
The guidelines focus on tests that are:
 commonly requested but may have limited clinical utility,
 commonly repeated unnecessarily,
 expensive and so will require SMO authorisation.
The guidelines have been organised into:
 Guideline development
 Choosing Wisely
 ED initiated tests
 Common tests: indications for testing and for repeat testing
 Expensive tests requiring SMO authorisation
The National Radiology Access Criteria note: “a useful investigation is one in which the result – positive or negative – may alter management and improve the outcome for the patient”.
The same reasoning applies to laboratory testing. Always ask whether the investigation meets these criteria. A significant number of laboratory investigations do not fulfil these aims.
Try and avoid repeating tests that have recently been performed. Check what tests have been done and ideally this should include reviewing the Path Lab results. Consider whether the test actually needs to be repeated and if the results will change management.
Screening for some conditions is inappropriate in sick patients in hospitals as tests can be falsely positive or give misleading results. Routine screening is best left to GPs.