Page 177 - Registrar Orientation Manual 2016

Reference:
Effective date:
2015
Expiry date:
2018
Page:
3 of 28
Title: Laboratory Testing Guidelines (DRAFT)
Type:
Clinical Guideline
Version:
01
Authorising initials:
Choosing Wisely
The American Boards in Internal Medicine have started an initiative to rationalise management.
The ABIM note:
“Waste and overuse are widespread in US medicine, affecting both the quality of care (up to 30,000 deaths annually from overuse) and costs to the health care system.”
Over 70 specialty societies have now created lists of tests or treatments that are overused, with the aim of avoiding unnecessary care.
Similar initiatives are being undertaken in Australasia as ‘Choosing Wisely Australia’ including the Royal Australian College of Physicians which has established the ‘Evolve’ program.
We have included all the relevant ‘Choosing Wisely’ recommendations in these guidelines.
In some cases, if more than one speciality society has made similar recommendations, they are combined.
The general recommendations are listed here:
General Recommendations from Choosing Wisely
Do not order repeated laboratory tests for patients transferred into the ED who have laboratory results within reference range available from the outside hospital.
Do not order screening laboratories (e.g., CBC, chemistry studies) for patients with uncomplicated gastroenteritis or viral syndromes.
Don’t do regular testing but test in response to clinical questions. Don’t do repeat CBC and biochemistry if clinically stable.
Don’t obtain baseline laboratory studies in patients without significant systemic disease undergoing low-risk surgery; specifically complete CBC, basic or a metabolic panel, or coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal.
See the following links for further information:
America’s Epidemic of Unnecessary Care - The New Yorker Choosing Wisely American Boards in Internal Medicine Choosing Wisely Website (with search engine)
Choosing Wisely Recommendations Australia ACEM 2015 US ACEM Top-Five List JAMA 2014
Choosing Wisely in the UK BMJ 2015