Lab Wisely in Canada: Enhancing and highlighting the role of all clinical laboratory professionals in reducing harm and waste

Introduction/Objective

Stewardship initiatives are a key strategy for addressing inappropriate utilization of clinical laboratory resources. These approaches require engagement of multiple types of stakeholders. Some professional groups are historically underrepresented, such as those who perform specimen collection, testing, and quality processes. A specific campaign is needed to engage these groups and highlight their expertise.

Methods/Case Report

We surveyed Medical Laboratory Technologists and Medical Laboratory Assistants to understand the barriers they face to participating in laboratory stewardship initiatives. These survey findings helped shape tools and resources that we created for new campaign called Lab Wisely. We also identified that one-third of existing Choosing Wisely Canada recommendations relate to laboratory testing. We categorized and tagged each recommendation to create a publicly-available searchable database which was placed on the campaign website (LabWisely.ca).

Results (if a Case Study enter NA)

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Conclusion

Laboratory testing is featured in a significant proportion of all Choosing Wisely Canada recommendations, supporting the idea that the clinical laboratory should be heavily involved in reducing medical overuse in healthcare. In our survey, we found that laboratory professionals face time and workload constraints, but feel a professional responsibility for ensuring appropriate resource use by all users. There was also a lack of ‘know- how’ around tangible ways to become involved. The Lab Wisely website has become a one-stop-shop for highlighting the role of technical and scientific professionals in laboratory stewardship and providing concrete tools that can be used to develop capacity in these groups. Every level of staff can and should be involved in improving the utilization of clinical laboratory services.

Evaluation of thyroid test utilization through analysis of population-level data

BACKGROUND

Inappropriate laboratory test utilization can result in unnecessary patient testing and increased healthcare costs. While several thyroid function tests are available, thyroid-stimulating hormone (TSH) is recommended as the first-line test for investigating and monitoring thyroid dysfunction. We evaluate thyroid test utilization in Northern Alberta in terms of testing patterns, frequencies, and reflex cutpoints.

METHODS

This retrospective study analyzed thyroid test requests from January to December 2014. Each request was designated as appropriate or potentially inappropriate as per clinical practice guidelines and Choosing Wisely recommendations, and the frequencies of each testing pattern were calculated. Sub-analysis was performed to categorize testing patterns based on physician specialty. The number of test requests per patient was determined to assess the appropriateness of testing frequency. Receiver operating characteristic (ROC) curves were generated to define optimal TSH cutpoints for automatic reflex to FT4 testing.

RESULTS

Of 752,217 test requests, approximately 10% were potentially inappropriate in terms of testing patterns. Free thyroxine (FT4) and free triiodothyronine (FT3) requested with TSH accounted for 59% of all potentially inappropriate test requests, and 49% of requests from endocrinologists (ENDO) were potentially inappropriate, occurring most frequently among those with less experience. Excessive testing frequencies were observed in 869 patients, accounting for 9382 test requests. Adjustment of our TSH reflex cutpoint would significantly increase specificity for identifying a low FT4 without compromising sensitivity.

CONCLUSIONS

This study suggests that questionable testing patterns, excessive testing frequencies, and suboptimal reflexive testing cutpoints contribute to inappropriate thyroid test utilization.