By request from the American Board of Internal Medicine (ABIM) Foundation, the American Society for Clinical Pathology (ASCP) is joining with the American Society for Clinical Laboratory Science (ASCLS) and the American Society for Microbiology (ASM) as they participate in the Choosing Wisely initiative.
Launched by the ABIM Foundation in 2012, the Choosing Wisely campaign aims to reduce test overuse and encourage clinicians and patients to question which tests are really necessary. ASCLS recently released its first set of recommendations reviewed by ASCP, identifying a number of laboratory tests that should be questioned:

  • Do not order a factor V Leiden mutation assay as the initial test to identify a congenital cause for a thrombotic event. First, order a phenotypic activated protein C resistance ratio assay.
  • Do not use herpes simplex virus (HSV) polymerase chain reaction (PCR) testing for genital HSV infection screening in adults and adolescents. Real-time HSV PCR testing should only be used to confirm herpes diagnosis in patients with suspected herpes.
  • Do not transfuse red blood cells as the sole intervention for expansion of circulatory volume unless deemed necessary for patients experiencing severe hemorrhage.
  • Avoid using hemoglobin to evaluate patients for iron deficiency in susceptible populations. Instead, use ferritin.
  • Do not order a comprehensive stool ova and parasite (O&P) microscopic exam on patients presenting with diarrhea of less than 7 days’ duration who have no immunodeficiency or no history of living in or traveling to endemic areas where gastrointestinal parasitic infections are prevalent. If symptoms of infectious diarrhea persist for 7 days or longer, start with molecular or antigen testing and next consider a full O&P microscopic exam if other testing is negative.

As part of the collaboration, ASCP has invited ASCLS and ASM to each appoint a representative to serve a 2-year term on ASCP’s effective test utilization committee. ASM has participated in the Choosing Wisely initiative for several years and will collaborate with ASCP on the initiative in the future.

“We are honored that the ABIM Foundation reached out to ASCP to assist our colleagues at ASCLS and ASM. It demonstrates the ABIM Foundation’s recognition of the work ASCP has done since 2012 to advance the Choosing Wisely initiative,” says ASCP past president Lee H. Hilborne, MD, MPH, DLM(ASCP)CM, FASCP, chair of the ASCP effective test utilization subcommittee.

Read more from the American Society for Clinical Pathology.