Lab Wisely

Want to improve lab utilization? Type in a test or procedure and see if Choosing Wisely Canada has a recommendation for you.

Category	Description
All Lab Disciplines	The recommendation relates to any/all laboratory disciplines.
Hematology	The recommendation relates to tests conducted to measure blood cells and to detect diseases/disorders of the blood, including coagulation testing. This category also includes tests conducted using flow cytometry.
Clinical Chemistry	The recommendation relates to blood and body fluid tests used to detect chemicals, hormones, and/or drugs.
Clinical Microbiology	The recommendation relates to tests conducted on blood, body fluid and/or tissue samples to detect bacteria, fungi, viruses, and/or parasites.
Transfusion Science	The recommendation relates to blood typing and blood compatibility tests and the preparation and issuing of blood, blood components, and plasma protein products within the transfusion science department.
Anatomical Pathology	The recommendation relates to the preparation of samples of body tissue for tests to detect disease.
Specimen Collection	The recommendation relates to the collection of samples for laboratory testing.
Molecular Genetics	The recommendation relates to tests conducted to analyze and diagnose changes or abnormalities in DNA.
Cytogenetics	The recommendation relates to tests conducted to analyze and diagnose changes or abnormalities in chromosomes.
Cytology	The recommendation relates to tests conducted on cells to analyze cellular changes to determine the presence of specific diseases, such as cancer.
Histocompatibility Testing	The recommendation relates to tests conducted to determine tissue compatibility and/or human leukocyte antigen (HLA) expression.

Category	Description
Relevant	This recommendation addresses an action that affects the work within a medical laboratory professional's scope of practice. This would include the pre-/post-analytical aspects of testing as well. For example, sample collection/handling, test ordering, ordering of products within the laboratory inventory
Possibly Relevant	This recommendation may have a possible effect on the work of a medical laboratory professional; however, whether the impact is significant is unclear.
Not Relevant	This recommendation does not fit within the scope of practice for a medical laboratory professional. It may describe an atypical or downstream effect with a limited impact.

Category	Description
Pre-preanalytical	The recommendation relates to initial procedures not performed in the clinical laboratory and not under the control of laboratory personnel.
Preanalytical	The recommendation relates to initial procedures completed before performing a laboratory test under the control of laboratory personnel (for example, patient identification, sample collection, sample handling, and sample preparation for analysis).
Analytical	The recommendation relates to the performance of laboratory tests or diagnostic procedures, processes and products that provide laboratory results.
Post-Analytical	The recommendation relates to procedures that occur after a laboratory test result is generated, under the control of laboratory personnel. This includes result entry, calculation, manipulation, and reporting.
Post-post-analytical	The recommendation relates to final procedures performed outside the laboratory, consisting of receiving, interpreting, and using laboratory information for patient management.

For more information on the brain-to-brain loop, please refer to Plebani M, Laposata M, Lundberg GD. The brain-to-brain loop concept for laboratory testing 40 years after its introduction. Am J Clin Pathol. 2011 Dec;136(6):829-33. doi: 10.1309/AJCPR28HWHSSDNON.

PMID: 22095366.

Category	Description
Ordering	The recommendation relates to the selection and ordering of a laboratory test
Collection	The recommendation relates to the collection of a specimen for laboratory testing.
Identification	The recommendation relates to patient identification for the purpose of laboratory testing.
Transportation	The recommendation relates to the transportation of specimens for laboratory testing.
Reception and Preparation	The recommendation relates to preparing specimens for laboratory analysis (receiving, centrifugation, aliquoting, etc.).
Analysis	The recommendation relates to the performance of laboratory test procedures.
Reporting	The recommendation relates to the reporting and transmission of laboratory test results.
Interpretation	The recommendation relates to the interpretation of laboratory test results.
Action	The recommendation relates to the action taken (further therapeutic interventions or treatments) resulting from a laboratory test.

A recent shift has occurred to place more effort into the study of “lab utilization,” which focuses on whether test orders are appropriate or inappropriate. This goes beyond historical efforts of Six Sigma and Lean projects to make our lab processes “effective and efficient,” a popular saying over the past couple of decades. The current trend places greater emphasis on the impact that lab utilization of tests and procedures can have on the system as a whole. This means looking at the lab as more than an assembly line of machines with dutiful workers. It sees patients, health care professionals and the health system (resources and fiscal responsibilities) as intertwined, and none of these components are less important than another. Thus, when we talk about effective and efficient lab utilization today, we encompass a greater sphere of responsibility and examine impact in a more meaningful way.

Did you know?

An estimated 20–50% of all testing is inappropriately ordered, meaning that it is either an incorrect test, a redundant test or a correct test ordered at the wrong time. ¹

This results in large amounts of wasted public money, misdirected clinical effort, increased workload and the potential for patient harm.

The reasons for inappropriate testing are numerous and can’t be pinned on a single concept. ² We work in a system full of limitations with predictable and unpredictable drivers, which influence the practice of all health professionals and ultimately, ordering practice.

We have reached a point in history where it is no longer a question of whether inappropriate testing is occurring. We now need to understand the extent it is occurring, why it persists and what can be done to create a sustainable future with minimal impact on the health system and those who utilize it. Here is what we know:

Almost $6 billion is spent annually on lab testing by provincial and territorial governments, and about 10% of that is unnecessary. ³
Large differences between individual practitioners in laboratory utilization have been reported in several countries. Canada is no exception. ⁴ ⁵
Across Organization for Economic Co-operation and Development (OECD) countries, it is estimated that one-fifth of health spending is inefficient. ⁶

How can we change this situation? In order to foster appropriate lab utilization, provide optimal care for patients and ensure our responsibility to the health care system, balanced strategies must be created.

Medical laboratory stakeholders have a supportive role to play in lab utilization.

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