In an effort to arm clinicians and patients with tools to help reduce unnecessary laboratory testing, a University of Alberta-led team has developed the first ever list of recommendations for medical laboratory science for Choosing Wisely Canada.
New recommendations aim to help health professionals and patients reduce needless tests
Started in Canada in 2014 following its conception in the United States in 2012, Choosing Wisely Canada acts as a national voice for reducing unnecessary testing and treatments in health care. The group works with various health-care professionals to develop recommendations that help both professionals and patients make evidence-based decisions about whether a test or procedure is appropriate.
Led by Amanda Van Spronsen—associate professor in the Faculty of Medicine & Dentistry and PhD candidate in the School of Public Health—and the Canadian Society for Medical Laboratory Science, the U of A team spent a year researching hundreds of potential recommendations before settling on a final seven. These include not collecting more blood than what is needed, not retesting at a frequency that is not backed by evidence and not allowing standing orders for repeat testing without a stop or review date.
“Although there are Choosing Wisely branches in over 20 countries, we're the only medical laboratory profession that has identified practices for itself,” explained Van Spronsen, ‘01 BSc. “One of the reasons that's unique and a little exciting is that medical laboratory professionals often feel that they are a bit misunderstood and don't have a voice in health care. So this list is a way to demonstrate we contribute to some of these bigger issues, like resource waste and patient harm within the health-care system, and can give us a larger voice on the health-care team.”
Van Spronsen’s list of seven recommendations is the first in the world specific to medical laboratory sciences, joining 59 other lists within Choosing Wisely Canada, including pathology, family and emergency medicine, and COVID-19.
The recommendations were developed through a national survey of medical laboratory professionals followed by a series of expert panels as well as evidence-based research, though Van Spronsen notes that was a bit challenging.
“Medical laboratory science isn’t a highly researched field, and many of the recommendations we had didn’t make the list because they didn’t have the evidence base to support them,” she said. “So part of our work moving forward is going to be creating a research agenda for our profession that digs into some of the ways we might be contributing to poor outcomes for patients, wasting money or enabling overtesting practices by other clinicians.”
According to the website Lab Wisely—an extension of the Choosing Wisely project that Van Spronsen has also been involved in, led by the Canadian Society for Medical Laboratory Science—about 10 per cent of lab tests are unnecessary, and as many as 50 per cent of all lab tests are inappropriately ordered. For example, the requested test could be the wrong test, a test that was already ordered or performed, or a test that is ordered at the wrong time.
Unnecessary testing results in wasted dollars and an increased workload and, most important, can increase risks of harm to patients, Van Spronsen said.
For example, in hospitals there is an association between the amount of blood being drawn for testing and the development of anemia, a condition in which there aren’t enough healthy red blood cells to properly transport oxygen around the body. There is also an increased risk of injury or infection, particularly in older patients, if blood is collected multiple times from the same site.
“It used to be that lab professionals would get admonished for questioning an order or pushing back a bit and not just doing what they’re told, and that sentiment is sometimes still there,” Van Spronsen said. “But things are slowly changing and this list is supporting that shift. Hopefully, it will give medical laboratory professionals a bit more of a leg to stand on to simply ask the question, ‘Is that test necessary?’
"At the same time, our hope is that these recommendations will also be helpful to clinicians to take away some of the mystery about lab testing and open up the channels of communication between our professions, demonstrating what we can offer to conversations about overtesting."