An assessment of overutilization and underutilization of laboratory tests by expert physicians in the evaluation of patients for bleeding and thrombotic disorders in clinical context and in real time

Mayukh K. Sarkar; Chad M. Botz; Michael Laposata

doi:10.1515/dx-2016-0042

Artikel

An assessment of overutilization and underutilization of laboratory tests by expert physicians in the evaluation of patients for bleeding and thrombotic disorders in clinical context and in real time

Mayukh K. Sarkar , Chad M. Botz und Michael Laposata

Veröffentlicht/Copyright: 20. Januar 2017

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Aus der Zeitschrift Diagnosis Band 4 Heft 1

Abstract

Background:

Diagnostic error is extremely common in the USA and likely around the world. A major reason for the diagnostic error is both the overutilization and the underutilization of laboratory tests. Using a panel of two to four experts in coagulation, test selection was reviewed in clinical context and in real time, and consensus determinations were made to derive conclusions about the extent of overutilization and underutilization.

Methods:

Two hundred cases of patients being evaluated for bleeding or thrombotic issues were presented at each daily meeting of the diagnostic management team, and a review of each case for appropriate utilization of tests was completed.

Results:

Two hundred randomly selected cases revealed 77.5% diagnostic errors (155 cases). Sixteen percent were associated with overutilization of laboratory tests, 44% were associated with underutilization, and 17.5% were associated with both. The annual cost burden estimated for overutilization alone in one institution of 450 beds was on the order of $20,000. The cost burden for the delay in diagnosis or the misdiagnosis in cases with underutilization is orders of magnitude greater ($200,000 or more), but it is impossible to determine the cost of a misdiagnosis in an individual case because it can produce many different clinical outcomes.

Conclusions:

This was a rare opportunity for experts in a given field to review cases in real time and in clinical context and provide immediately a consensus answer about test utilization. The results of this study show errors in test selection in nearly 75% of the cases evaluated.

Keywords: coagulation; laboratory test selection; overutilization; underutilization

Corresponding author: Michael Laposata, MD, PhD, Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA

Acknowledgments

We would like to thank J. Alperin, MD, A. Koutrouvelis, MD, O. Oladipo, MD, and the residents in the pathology department rotating on the coagulation service at UTMB. We would also like to thank the staff of the Hematopathology clinical laboratory for providing us with the information for coagulation test pricing.

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2016-11-15

Accepted: 2016-11-22

Published Online: 2017-1-20

Published in Print: 2017-3-1

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Artikel in diesem Heft

https://doi.org/10.1515/dx-2016-0042

Schlagwörter für diesen Artikel

coagulation; laboratory test selection; overutilization; underutilization