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Under-ordered or Misordered Tests

Most of laboratory utilization tends to revolve around restricting tests. However, some tests may be under-utilized. Below are some examples of tests that are often misordered, ordered too infrequently, or ordered at the wrong times:
  • Therapeutic drug tests that are ordered at the wrong time. One study shows that 25% of toxic digoxin levels were found to be caused by inappropriately timed specimen collection.
  • Inpatients on unfractionated heparin therapy must have coagulation monitoring in the first 12 hours and a platelet count within the first 72 hours. These tests are not always ordered.
  • Lipids: 13% of participants in one study with prior stroke or myocardial infarction had undiagnosed hypercholesterolemia, even though 83% of them had seen a physician in the previous six months.

It's important to remember that the UM team needs to work towards proper utilization of tests, not just towards decreasing lab testing volumes.