The American Society for Clinical Pathology (ASCP) has released an updated list of recommendations for laboratory tests that are commonly ordered but not always appropriate in pathology and laboratory medicine. The list is part of the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation, which collaborates with the medical professions in order to improve healthcare.
The new list of five targeted, evidence-based recommendations expands ASCP’s existing list to 30 recommendations. The list is designed to support conversations between patients and physicians about what care is really necessary. The additional recommendations make ASCP the most prolific contributor to the ABIM Foundation campaign. ASCP’s new Choosing Wisely recommendations are:
- Do not routinely test for community gastrointestinal stool pathogens in hospitalized patients who develop diarrhea after day 3 of hospitalization.
- Do not repeat hepatitis C virus antibody testing in patients with a previous positive hepatitis C virus test. Instead, order hepatitis C viral load testing for assessment of active versus resolved infection.
- Do not perform a hypercoagulable workup in patients taking direct factor Xa or direct thrombin inhibitors 26.
- Don’t use plasma catecholamines to evaluate a patient for pheochromocytoma or paraganglioma; instead use plasma free metanephrines or urinary fractionated metanephrines.
- Do not routinely order broad respiratory pathogen panels unless the result will affect patient management.
The expanded recommendations were developed under the leadership of Lee Hilborne, MD, MPH, FASCP, DLM(ASCP), chair of ASCP’s effective test utilization steering committee and a past president of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in the process for their expertise and guidance.
“As ASCP continues to expand our recommendations, we expect to see increasing higher quality, appropriate care with lower costs, and more effective use of our medical laboratory resources and personnel,” says Hilborne. “Choosing Wisely aims to encourage clinician and patient conversations across all disciplines of medicine. ASCP’s work focuses on highlighting potentially unnecessary and sometimes harmful care in pathology and laboratory medicine.”
Examples of inappropriate and overutilized tests are frequent throughout both anatomic and clinical pathology and laboratory medicine, according to ASCP. The medical laboratory tests targeted in the new recommendations were selected because they are tests that are commonly performed; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and does not provide higher quality patient care; and eliminating it or changing to another test is within the control of the clinician.
“ASCP has been one of our most stalwart partners in the Choosing Wisely campaign,” says Richard J. Baron, MD, president and CEO of the ABIM Foundation. “Without committed relationships such as this one, the ABIM Foundation would not have been able to achieve the success it has in spreading awareness about and spurring action on overuse in healthcare.”
More than 80 specialty medical societies have joined the Choosing Wisely campaign since its inception in April 2012. To date, more than 600 recommendations regarding tests and procedures have been released as part of the campaign, and the specialty societies have undertaken considerable efforts to share the recommendations with their collective memberships.
For more information, visit ASCP.