Improving appropriateness in laboratory medicine: How, when and why

Abstract

The issue of the appropriateness in laboratory medicine has been discussed from several years in association to the parallel onset of two aspects: 1) the significant increase in tests demand and utilization, thanks to the development of laboratory automation and information laboratory systems (LIS), that allow to provide timely and reliable results to clinicians; 2) the opportunity, thanks to new pathophysiological knowledge and new technologies to introduce new and more sophisticated tests in clinical practice, providing a relevant support to the clinician in the management of patients, according to the improved vision of personalized medicine. As a consequence, the potential inappropriateness in test utilization and the need to manage demand and to reduce the redundant testing have received increasing concern. Several papers, in the recent literature, demonstrated that the inappropriateness in laboratory test utilization may represent a potential source of errors, and interesting strategies have been proposed and progressively adopted in order to limit this problematic outcome. An essential issue is to assure appropriateness not only in test request, but in all steps of the testing cycle. In particular, some of the more relevant issues has been linked to: rationalization of laboratory test ordering prescription, thanks to development of a computerized clinical decision support systems; implementation of the reflexing tests rule; definition of the minimum retesting interval according to the clinical and pathophysiological criteria; timely revision of the available panel tests in order to delete those considered obsolete from clinical and analytical point-of-view and, finally, improving the education in demand management. The “clinical laboratory stewardship” seems to be the new and shared strategy, that guarantees not only the appropriate utilization and interpretation of laboratory tests improving efficacy and providing efficiency but, more importantly, the future of the discipline and the role of laboratory professionals in the context of new and more complicated clinical and economical scenarios.