Clin Lab. 2021 Jul 1;67(7). doi: 10.7754/Clin.Lab.2020.201019.
The failure to order the correct diagnostic test at the right time is one of the major contributing factors of diagnostic error. Excessive testing can lead to added economic burden and addressing underutilization is precarious as clinicians often fail to order the tests that would improve diagnosis, prognosis, and management.
A retrospective analysis of errors in test orders of thyroid function testing (TFT) in 321 pregnant women suspected of clinical and subclinical thyroid disorders was performed. Test selection was evaluated, and determinations were made about the extent of overutilization and underutilization of TFTs in reviewing each individual patient case by a Doctorate in Clinical Laboratory Science (DCLS) scholar.
About 77% (247 cases) of the cases were found to have errors associated with test ordering for TFT. Of the cases reviewed, 18% cases were associated with overutilization, 53% of the cases were associated with underutilization, and 7% were associated with both (overutilization and underutilization). The annual cost burden because of ordering unnecessary tests was estimated to be approximately $13,000. The cost burden from errors resulting from not ordering a test would be of much greater magnitude but was difficult to estimate because underutilization has a ripple effect and may cause prolonged hospital stays, unnecessary medical bills, and delayed/ missed diagnosis leading to poor outcomes for patients.
This study evaluated whether proper utilization of TFT were made at maternal health clinic locations of a large academic medical center in pregnant women to diagnose thyroid disorder and reported the issue of wastage of resources in the clinical laboratory. The study findings show significant errors in ordering of TFT for pregnant women in more than 75% of the cases that was based on evidence-based review of patient cases.
未能在适当的时间正确开具诊断性检查是导致诊断错误的主要因素之一。过度检查会导致额外的经济负担，而解决利用不足的问题也很棘手，因为临床医生经常未能开具可以改善诊断、预后和治疗的检查。
对 321 名疑似临床和亚临床甲状腺疾病的孕妇进行甲状腺功能检测（TFT）的检查医嘱错误进行回顾性分析。由临床检验博士（DCLS）学者对每个患者的检查进行评估，评估检查选择，并确定 TFT 的过度利用和利用不足的程度。
约 77%（247 例）的病例存在与 TFT 检查医嘱相关的错误。在审查的病例中，18%的病例与过度利用有关，53%的病例与利用不足有关，7%的病例与过度利用和利用不足都有关。由于开具不必要的检查而导致的年度费用负担估计约为 13,000 美元。由于未开具检查而导致的错误所造成的费用负担会更大，但难以估计，因为利用不足会产生连锁反应，可能导致住院时间延长、不必要的医疗费用增加以及诊断延误/漏诊，从而导致患者预后不佳。
本研究评估了在大型学术医疗中心的产妇保健诊所是否对孕妇进行了适当的 TFT 检查以诊断甲状腺疾病，并报告了临床实验室资源浪费的问题。研究结果表明，在超过 75%的病例中，基于对患者病例的循证审查，存在开具 TFT 检查的明显错误。
