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Inappropriate requests of viral hepatitis serologic tests

Year 2012, Volume: 3 Issue: 2, 181 - 184, 01.06.2012
https://doi.org/10.5799/ahinjs.01.2012.02.0140

Abstract

Objectives: Inappropriate end excessive requests of laboratory tests are labor intensive and a vast burden of cost. Diagnostic algorithms are advised to prevent inappropriate and excessive usage of tests. In this study it was aimed to determine inappropriate test ordering rates and cost. Materials and methods: To assess the number of inappropriate test orders, laboratory records of samples sent for hepatitis A and B viral serologic tests were evaluated retrospectively with respect to diagnostic algorithms. Orders including serological marker groups without adequate clinical information whether or not the order was inappropriate was excluded from the study. Results: According to the diagnostic algorithms 1.452 anti-HAV IgM tests, 1.452 anti-HAV total tests, 208 anti-HBs tests, 208 anti-HBc total tests, 1.210 anti-HBc IgM tests, 1.358 HBeAg tests and 1.216 anti-HBe tests are inappropriate requests. Total cost of these tests is calculated as 56.153 TL. Conclusion: This study shows that a significant amount of hepatitis serologic tests are inappropriate requests. Diagnostic algorithms for hepatitis should be used more commonly to decrease the amount of inappropriate requests result in significant workload and cost. J Clin Exp Invest 2012; 3(2): 181-184

References

  • Winkens R, Dinant GJ. Evidence base of clinical diag- nosis: rational, cost effective use of investigations in clinical practice. BMJ 2002;324(7340):783-4.
  • Fawkes FG, Catford JC, Logan RF. Containing the use of laboratory tests. BMJ 1985;290(6467):488-90.
  • Kwok J, Jones B. Unnecessary repeat requesting of tests: an audit in a government hospital immunology laboratory. J Clin Pathol 2005;58(5):457-62.
  • Erasmus RT, Zemlin AE. Clinical audit in the laboratory. J Clin Pathol 2009;62(7):593-7.
  • Bareford D, Hayling A. Inappropriate use of laboratory services: long term combined approach to modify re- quest patterns. BMJ 1990;301(6764):1305-7.
  • Pilon CS, Leathley M, London R et al. Practice guide- line for arterial blood gas measurement in the inten- sive care unit decreases numbers and increases appropriateness of tests. Critical Care Medicine 1997;25(8):1308-13.
  • Ozbek OA, Oktem MA, Dogan G, Abacioglu YH. Ap- plication of hepatitis serology testing algorithms to as- sess inappropriate laboratory utilization. J Eval Clin Pract 2004;10(4):519-23.
  • Goodwin JS, Asrabadi A, Howrey B, Giordano S, Kuo YF. Multiple measurements of serum lipids in the el- derly. Medical Care 2011;49(2):225-30.
  • Wong ET. Improving laboratory testing: can we get physicians to focus on outcome? Clin Chem 1995;41(8):1241-7.
  • Zaat JO, van Eijk JT. General practitioners’ uncertain- ty, risk preference, and use of laboratory tests. Med Care 1992;30(9):846-54.
  • Little P, Cantrell T, Roberts L et al. Why do GP’s per- form investigations? The medical and social agendas in arranging back X-rays. Fam Pract 1998;15(3):264- 5.
  • McDonald IG, Daly J, Jelinek WM et al. Opening Pan- dora’s box: the unpredictability of reassurence by a normal test result. BMJ 1996;313(7053):329-32.
  • van Walraven C, Naylor CD. Do we know what inap- propriate laboratory utilization is? A systematic review of laboratory clinical audits. JAMA 1998;280(6):550-8.
  • Mıstık R, Balık I. Epidemiologic analysis of viral hepa- titis in Turkey. In: Kılıcturgay K, Badur S (eds) Viral hepatitis 2001 1st ed. VHSD, Istanbul, 2001:10-55.
  • Ozer TT, Yula E, Deveci O, Yanik K, Durmaz S, Tekin A. Evaluation of the screening test results before mar- riage. J Clin Exp Invest 2011;2(3):292-4.
  • Deveci O, Tekin A, Gunbay SS et al. Evaluation of HBs Ag, anti-HCV, anti-HIV and VDRL test results in blood donors. J Clin Exp Invest 2011;2(4):416-9.
  • Wu AH. Improving the utilization of clinical laboratory tests. J Eval Clin Pract 1998;4(3):171-8.
  • Ahmed A, Keefe EB. Cost-effective evaluation of acute viral hepatitis. West J Med 2000;172(1):29-32.
  • Sacher RA, Peters SM, Bryan JA. Testing for vi- ral hepatitis. A practice parameter. Am J Clin Pathol 2000;113(1):12-7.
  • Centers for Disease Control and Prevention. Guide- lines for laboratory testing and result reporting of antibody to hepatitis C virus. Morbidity and Mortality Weekly Report 2003;52:1-15.
  • Akdağ R. Financial management in health care. In: Akdag R (ed). Turkey Health Transformation Evalua- tion Program Evaluation Report (2003-2010) Ministry of Health, Ankara, 2011;263-300.
  • Sahin S, Durmaz Y, Yakinci C. The comparison of an- tibody titers secondary to intramuscularly, subcutane- ous or intradermal application of low dose Hepatitis B vaccine. J Clin Exp Invest 2011;2(3):271-81.
  • Bendinelli M, Pistello M, Maggi F, Vatteroni M. Blood- borne hepatitis viruses: hepatitis B, C, D and G virus- es and TT virus. In: Specter RL, Hodinka RL, Young SA (eds) Clinical Virology Manual 3rd ed. American Society for Microbiology, Washington, 2000:306-37.
  • Labib M, Howell P. Design of pathology request forms. Lancet 1993;342(8871):620-2.
  • Ozbek OA, Oktem MA, Akyuz E. Unnecessary test repeats in viral hepatitis serology. Mikrobiyol Bul 2007;41(2):279-83.
  • Sharma A, Salzman M. The effect of automated test rejection on repeat requesting. J Clin Pathol 2007;60(8):954-5.
  • Hyams AL, Brandenburg JA, Lipsitz SR, Shap- iro DW, Brennan TA. Practice guidelines and mal- practice litigation: a two-way street. Ann Intern Med 1995;122(6):450-5.
  • Bates DW, Kuperman G, Teich JM. Computerized physician order entry and quality of care. Qual Manag Health Care 1994;2(4):18-27.
  • Sitting DF, Stead WW. Computer-based physician or- der entry: the state of the art. J Am Med Inform Assoc 1994;1(2):108-23.
  • Tierney WM, Miller ME, Overhage JM, et al. Phy- sician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA 1993;269(3):379-83.

Inappropriate requests of viral hepatitis serologic tests

Year 2012, Volume: 3 Issue: 2, 181 - 184, 01.06.2012
https://doi.org/10.5799/ahinjs.01.2012.02.0140

Abstract

Amaç: Laboratuvar testlerinin uygunsuz ve aşırı istemi ciddi bir iş yükü ve maliyete neden olmaktadır. Gereksiz ve fazla test kullanımını önlemek için çeşitli tanısal algoritmalar önerilmektedir. Bu çalışmada tanısal algoritmalara göre hepatit serolojisinde uygunsuz test istemlerinin oranı ve getirdiği mali yükün belirlenmesi amaçlanmıştır. Gereç ve yöntem: Uygunsuz test istemlerinin sayısının belirlenmesi için hepatit A ve B viral serolojik testleri viral hepatit tanısında kullanılan serolojik tanısal algoritmalara göre retrospektif olarak değerlendirilmiştir. Hepatit A ve B tanısında kullanılan testlerden hastanın klinik durumunu ortaya koyacak şekilde yapılan test istemleri çalışmaya dahil edilmiş, hastalığın klinik evresi ile ilgili yetersiz test istemi nedeniyle bilgi edinilemeyen testler çalışmadan çıkarılmıştır. Bulgular: Tanısal algoritmalara gore; 1452 anti-HAV IgM testinin, 1452 anti-HAV total testinin, 208 anti-HBs testinin, 208 anti-HBc total testinin, 1210 anti-HBc IgM testinin, 1358 HBeAg testinin, 1216 anti-HBe testinin uygunsuz istem olduğu belirlenmiştir. Bu testlerin toplam maliyeti 56.153 TL olarak hesaplanmıştır. Sonuç: Bu çalışma viral hepatit serolojisinde kullanılan testlerin önemli bir kısmının uygunsuz istem olduğunu göstermektedir. Tanısal algoritmalar, ciddi bir iş yükü ve maliyet getiren uygunsuz test istemlerini azaltmak için daha yaygın olarak kullanılmalıdır.

References

  • Winkens R, Dinant GJ. Evidence base of clinical diag- nosis: rational, cost effective use of investigations in clinical practice. BMJ 2002;324(7340):783-4.
  • Fawkes FG, Catford JC, Logan RF. Containing the use of laboratory tests. BMJ 1985;290(6467):488-90.
  • Kwok J, Jones B. Unnecessary repeat requesting of tests: an audit in a government hospital immunology laboratory. J Clin Pathol 2005;58(5):457-62.
  • Erasmus RT, Zemlin AE. Clinical audit in the laboratory. J Clin Pathol 2009;62(7):593-7.
  • Bareford D, Hayling A. Inappropriate use of laboratory services: long term combined approach to modify re- quest patterns. BMJ 1990;301(6764):1305-7.
  • Pilon CS, Leathley M, London R et al. Practice guide- line for arterial blood gas measurement in the inten- sive care unit decreases numbers and increases appropriateness of tests. Critical Care Medicine 1997;25(8):1308-13.
  • Ozbek OA, Oktem MA, Dogan G, Abacioglu YH. Ap- plication of hepatitis serology testing algorithms to as- sess inappropriate laboratory utilization. J Eval Clin Pract 2004;10(4):519-23.
  • Goodwin JS, Asrabadi A, Howrey B, Giordano S, Kuo YF. Multiple measurements of serum lipids in the el- derly. Medical Care 2011;49(2):225-30.
  • Wong ET. Improving laboratory testing: can we get physicians to focus on outcome? Clin Chem 1995;41(8):1241-7.
  • Zaat JO, van Eijk JT. General practitioners’ uncertain- ty, risk preference, and use of laboratory tests. Med Care 1992;30(9):846-54.
  • Little P, Cantrell T, Roberts L et al. Why do GP’s per- form investigations? The medical and social agendas in arranging back X-rays. Fam Pract 1998;15(3):264- 5.
  • McDonald IG, Daly J, Jelinek WM et al. Opening Pan- dora’s box: the unpredictability of reassurence by a normal test result. BMJ 1996;313(7053):329-32.
  • van Walraven C, Naylor CD. Do we know what inap- propriate laboratory utilization is? A systematic review of laboratory clinical audits. JAMA 1998;280(6):550-8.
  • Mıstık R, Balık I. Epidemiologic analysis of viral hepa- titis in Turkey. In: Kılıcturgay K, Badur S (eds) Viral hepatitis 2001 1st ed. VHSD, Istanbul, 2001:10-55.
  • Ozer TT, Yula E, Deveci O, Yanik K, Durmaz S, Tekin A. Evaluation of the screening test results before mar- riage. J Clin Exp Invest 2011;2(3):292-4.
  • Deveci O, Tekin A, Gunbay SS et al. Evaluation of HBs Ag, anti-HCV, anti-HIV and VDRL test results in blood donors. J Clin Exp Invest 2011;2(4):416-9.
  • Wu AH. Improving the utilization of clinical laboratory tests. J Eval Clin Pract 1998;4(3):171-8.
  • Ahmed A, Keefe EB. Cost-effective evaluation of acute viral hepatitis. West J Med 2000;172(1):29-32.
  • Sacher RA, Peters SM, Bryan JA. Testing for vi- ral hepatitis. A practice parameter. Am J Clin Pathol 2000;113(1):12-7.
  • Centers for Disease Control and Prevention. Guide- lines for laboratory testing and result reporting of antibody to hepatitis C virus. Morbidity and Mortality Weekly Report 2003;52:1-15.
  • Akdağ R. Financial management in health care. In: Akdag R (ed). Turkey Health Transformation Evalua- tion Program Evaluation Report (2003-2010) Ministry of Health, Ankara, 2011;263-300.
  • Sahin S, Durmaz Y, Yakinci C. The comparison of an- tibody titers secondary to intramuscularly, subcutane- ous or intradermal application of low dose Hepatitis B vaccine. J Clin Exp Invest 2011;2(3):271-81.
  • Bendinelli M, Pistello M, Maggi F, Vatteroni M. Blood- borne hepatitis viruses: hepatitis B, C, D and G virus- es and TT virus. In: Specter RL, Hodinka RL, Young SA (eds) Clinical Virology Manual 3rd ed. American Society for Microbiology, Washington, 2000:306-37.
  • Labib M, Howell P. Design of pathology request forms. Lancet 1993;342(8871):620-2.
  • Ozbek OA, Oktem MA, Akyuz E. Unnecessary test repeats in viral hepatitis serology. Mikrobiyol Bul 2007;41(2):279-83.
  • Sharma A, Salzman M. The effect of automated test rejection on repeat requesting. J Clin Pathol 2007;60(8):954-5.
  • Hyams AL, Brandenburg JA, Lipsitz SR, Shap- iro DW, Brennan TA. Practice guidelines and mal- practice litigation: a two-way street. Ann Intern Med 1995;122(6):450-5.
  • Bates DW, Kuperman G, Teich JM. Computerized physician order entry and quality of care. Qual Manag Health Care 1994;2(4):18-27.
  • Sitting DF, Stead WW. Computer-based physician or- der entry: the state of the art. J Am Med Inform Assoc 1994;1(2):108-23.
  • Tierney WM, Miller ME, Overhage JM, et al. Phy- sician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA 1993;269(3):379-83.
There are 30 citations in total.

Details

Primary Language Turkish
Journal Section Research Article
Authors

Harun Ağca This is me

Publication Date June 1, 2012
Published in Issue Year 2012 Volume: 3 Issue: 2

Cite

APA Ağca, H. (2012). Inappropriate requests of viral hepatitis serologic tests. Journal of Clinical and Experimental Investigations, 3(2), 181-184. https://doi.org/10.5799/ahinjs.01.2012.02.0140
AMA Ağca H. Inappropriate requests of viral hepatitis serologic tests. J Clin Exp Invest. June 2012;3(2):181-184. doi:10.5799/ahinjs.01.2012.02.0140
Chicago Ağca, Harun. “Inappropriate Requests of Viral Hepatitis Serologic Tests”. Journal of Clinical and Experimental Investigations 3, no. 2 (June 2012): 181-84. https://doi.org/10.5799/ahinjs.01.2012.02.0140.
EndNote Ağca H (June 1, 2012) Inappropriate requests of viral hepatitis serologic tests. Journal of Clinical and Experimental Investigations 3 2 181–184.
IEEE H. Ağca, “Inappropriate requests of viral hepatitis serologic tests”, J Clin Exp Invest, vol. 3, no. 2, pp. 181–184, 2012, doi: 10.5799/ahinjs.01.2012.02.0140.
ISNAD Ağca, Harun. “Inappropriate Requests of Viral Hepatitis Serologic Tests”. Journal of Clinical and Experimental Investigations 3/2 (June 2012), 181-184. https://doi.org/10.5799/ahinjs.01.2012.02.0140.
JAMA Ağca H. Inappropriate requests of viral hepatitis serologic tests. J Clin Exp Invest. 2012;3:181–184.
MLA Ağca, Harun. “Inappropriate Requests of Viral Hepatitis Serologic Tests”. Journal of Clinical and Experimental Investigations, vol. 3, no. 2, 2012, pp. 181-4, doi:10.5799/ahinjs.01.2012.02.0140.
Vancouver Ağca H. Inappropriate requests of viral hepatitis serologic tests. J Clin Exp Invest. 2012;3(2):181-4.