Using Labs Wisely: Toolkit

Using Labs Wisely (ULW) is a national Canadian collaborative designed to address overuse of laboratory testing in acute care. The ULW community has a wealth of experience identifying unnecessary blood testing using the ULW national laboratory registry for peer-to-peer benchmarking and tackling overuse through multimodal improvement programs. This toolkit synthesizes the ULW collaborative experience and common tools used to reduce unnecessary testing.

Overuse of blood testing is common, harmful to patients, and fiscally and environmentally inefficient for the healthcare system.

The estimated prevalence of unnecessary testing varies widely, with studies reporting variation between 16 – 56%. Since blood testing is a high-volume activity accounting for over 5.9 Billion CAD annually, even a small proportion of unnecessary testing can have a large impact on patients and the health system. Collectively the benefits of reducing unnecessary testing are sometimes referred to as the “Triple Bottom Line”.

“Triple Bottom Line”.

Unnecessary blood testing comes in many forms, such as the persistent use of outdated or diagnostically imprecise tests, bundling or coupling of non-indicated tests in order sets for convenience, and repetitive testing without clear indication or rationale. Different health systems have unique and often context specific over-use challenges. However, the Canadian ULW national collaborative has experience implementing rationale test ordering practices for “quick win” tests across many organizations including AST, Urea, CK-MB, PTT, Folate, ESR, B12, Routine or “Daily” testing. These tests form the foundation for the toolkit, though the general approaches described can be deployed for any context specific blood test over use challenge.

Overuse of blood testing is widespread and driven by historical practices. Many tests such as AST, Urea, CK-MB, ESR, Folate, B12, PTT/INR remain in use or are overused due to outdated practices, bundled order sets, or misconceptions about diagnostic value. Routine or daily blood testing are often embedded in hospital culture, although evidence shows they are unnecessary in 16-56% of cases

Purpose

This toolkit is designed to provide acute care organizations a starting point for blood testing stewardship QI initiatives by providing:

• General strategies to reduce unnecessary blood testing that can be applied to a wide range of common tests
• Test specific guidance and tools to reduce overuse of common lab stewardship targets including; AST, Urea, Coagulation Studies, Folate, CK-MB, ESR, and B12

Target Audience

This toolkit is intended for hospital-based clinicians, biochemists, laboratory specialists, and hospital administration/leadership working or leading change within acute care settings