是否进行检测：南澳大利亚医院病理检测潜在不适当使用的回顾性横断面研究。

To test or to not test: A retrospective cross-sectional study on potentially inappropriate use of pathology testing in South Australian hospitals.

机构信息

Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia.

SA Pathology, Adelaide, Australia.

出版信息

Am J Clin Pathol. 2024 Apr 3;161(4):342-348. doi: 10.1093/ajcp/aqad153.

DOI:10.1093/ajcp/aqad153

PMID:37975596

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10988106/

Abstract

OBJECTIVES

To measure rates of potentially inappropriate pathology testing in the hospital setting.

METHODS

Retrospective cross-sectional study in hospital setting from July 2021 to December 2021. We examined 3 potentially inappropriate uses: overordering, selection errors, and unnecessary repeat testing. Overordering included vitamin D and lipids (rarely required in acute hospital care). Selection error was the ratio of iron studies to standalone ferritin requests. Unnecessary repeats included any repeat vitamin D, lipids, iron, or ferritin in an episode of care or C-reactive protein (CRP) repeated within 3 days and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 7 days and repeated previously abnormal CRP and NT-proBNP tests. Costs of inappropriate tests were estimated using the Australian Medicare Benefits Schedules.

RESULTS

Among 55,904 test requests, 15% (n = 8120) were potentially inappropriate. Vitamin D was frequently ordered (n = 4498), as were lipids (n = 2872). Ratio of iron studies to standalone ferritin was 36. Of 19,233 repeat CRPs, 36% (n = 6947) were within 3 days and 62% (n = 179) of repeat NT-proBNPs were within 7 days of the first test. For initially abnormal tests, 89% of CRPs and 97% of NT-proBNPs remained abnormal. Inappropriate test costs accounted for 12% to 30% of costs.

CONCLUSIONS

Frequent potential inappropriate use and selection of pathology tests was observed in South Australian hospitals.

摘要

目的

测量医院环境中潜在不适当的病理检验率。

方法

在 2021 年 7 月至 2021 年 12 月的医院环境中进行回顾性横断面研究。我们检查了 3 种潜在的不适当用途：过度订购、选择错误和不必要的重复测试。过度订购包括维生素 D 和脂质（在急性医院护理中很少需要）。选择错误是指铁研究与单独铁蛋白请求的比值。不必要的重复包括在一次治疗过程中重复任何维生素 D、脂质、铁或铁蛋白，或在 3 天内重复 C-反应蛋白（CRP）和在 7 天内重复 N-末端脑利钠肽前体（NT-proBNP），以及之前异常的 CRP 和 NT-proBNP 测试重复。使用澳大利亚医疗保险福利时间表估计不适当测试的成本。

结果

在 55904 项测试请求中，有 15%（n=8120）是潜在不适当的。维生素 D 经常被订购（n=4498），脂质也是如此（n=2872）。铁研究与单独铁蛋白的比值为 36。在 19233 次重复 CRP 中，有 36%（n=6947）在 3 天内，62%（n=179）的重复 NT-proBNP 在第一次测试后的 7 天内。对于最初异常的测试，89%的 CRP 和 97%的 NT-proBNP 仍然异常。不适当测试的费用占费用的 12%至 30%。