Page 176 - Registrar Orientation Manual 2016

Reference:
Effective date:
2015
Expiry date:
2018
Page:
2 of 28
Title: Laboratory Testing Guidelines (DRAFT)
Type:
Clinical Guideline
Version:
01
Authorising initials:
Guideline Development
The Best Practice Advocacy Centre (BPAC) has an excellent summary of the general principles of laboratory investigations in primary care. These also apply to hospital practice.
The BPAC emphasize “Testing, testing: one, two, three”
1. Think twice before you test
2. Select the right test, at the right time, for the right patient
3. Askyourself:canIimprovemytesting?
A Laboratory Test Schedule was developed by DHB Shared Services in 2013. Guidance is provided on the ordering of laboratory tests but the authors note that RMOs and other clinicians who order tests in a hospital setting have not been specifically considered as part of this process.
In the schedule, tests have been categorised as ‘Tier One’ and ‘Tier Two’ tests. A ‘Tier One’ test is able to be ordered by any medical practitioner; a ‘Tier Two’ test requires the clinician to have appropriate vocational registration or credentialing to be able to order the test.
See the www.DHBSHAREDSERVICES.HEALTH.NZ for further details.
Laboratory Test Referral Guidelines have also been developed by DHB Shared Services. This 73 page document provides an overview of the indications for testing, referral criteria and recommendations on frequency of testing, but only for some of the tests on the schedule.
It is noted these guidelines do not override established local care pathways or guidelines which represent local consensus but the authors hope local clinical pathways are consistent with these guidelines, and the guidelines will be used to inform and supplement them, which we have done.
We have based our guidelines on the Shared Services recommendations and the Choosing Wisely recommendations (see next page). In the interests of space we have abbreviated them.
Where no guideline exists for the test we have tried to get a consensus from senior clinicians working in the Waikato DHB. Again, in the interests of space, we have limited the recommendations to the key points that may help prevent unnecessary testing.
DHB Shared Services Laboratory Test Referral Guidelines recommendations are in green.
Choosing Wisely recommendations are in red. Our own recommendations are in bold black font.
The Laboratory Test Schedule also includes comprehensive guidelines on genetic testing and emphasize that clinicians seek advice before requesting tests. The BPAC site also has a very useful document summarising the available genetic tests and their role in primary care.
There is a limit to how much effect having guidelines will have on clinician’s practice. In the future electronic ordering will include forcing functions that will prevent inappropriate testing and the frequent repeating of tests without clinical justification. Until then we have to rely on limited laboratory rules, the education of RMOs to change practice and clinical audit.
The DHB Shared Services’ Working Group supports the need for an electronic platform, integrated into Practice Management Software. The Ministry of Health is currently undertaking work to code the tests for this purpose. The Ministry note that until we get electronic ordering of laboratory tests, the schedule and guidelines will be used as a point of reference.