Clinlab Navigator

Test Utilization

Additional Resources:

PowerPoint - How to Successfully Influence Test Utilization & Improve Laboratory Efficiency

PowerPoint - SLH Clinical Pathologist - Responsibilities and Roles

PowerPoint - How the Clinical Laboratory Enhances Patient Care


Below is a summary of initiatives that laboratories can implement to reduce excessive, ineffective, unnecessary and redundant testing.


  • Educate physicians about appropriate test utilization on a continual basis with a laboratory newsletter
  • Respond promptly to physician calls regarding test ordering and interpretation
  • Design test requisitions to encourage optimal test ordering
  • Discontinue obsolete tests
  • Discontinue low volume tests, especially if you are running more quality control samples than patients
  • Have pathologists review lab tests incorporated into clinical pathways
  • Have pathologists review orders for esoteric tests sent to reference laboratories
  • Renegotiate pricing for send out tests on a regular basis
  • Review send out test volumes annually and bring high volume tests in house
  • Store specimens in lab for one week for add-on tests
  • Eliminate replicate testing of normal and abnormal results
  • Eliminate large volume venipuncture tubes
  • Decrease laboratory error rate to reduce number of repeat test orders
  • Set allowable time intervals for repeat testing in hospital information system
  • Implement autoverification whenever feasible
  • Merge outpatient and inpatient electronic medical records to reduce number of tests ordered on admission
  • Discourage writing of daily orders and set limits for mandatory rewriting of orders
  • Compare physician test utilization for a specific DRG with their peers
  • Discourage routine ordering of preoperative screening tests
  • Improve turnaround times to reduce tendency to reorder pending tests
  • Determine which confirmatory tests should be performed during the inpatient versus the outpatient setting
  • Evaluate reference ranges periodically to decrease follow-up testing for slightly abnormal results
  • Establish guidelines to determine medical necessity of new test requests
  • Ask clinicians to refer point of care vendors to the medical director of the laboratory


  • Change stat urine medical drug screens from comprehensive to Triage drug screen
  • Eliminate large chemistry panels except for Medicare approved panels
  • Require separate order for arterial blood gases and co-oximetry
  • Change anti-nuclear antibody cutoff from 1:40 to 1:160
  • Eliminate vancomycin peak levels for therapeutic monitoring
  • Eliminate total CK from Cardiac Marker Panel
  • Replace Amniostat PG with FLM II as first step in fetal lung profile to reduce two dimensional L/S ratio volume by ~50%
  • Do not perform immunofixation without prior serum protein electrophoresis
  • Change quality control for precise automated instruments to single 3 SD rule
  • Screen for thyroid disease with TSH and reflex to free T4 if abnormal
  • Do not perform chemistry panels on body fluids; limit testing to protein, LD, pH, glucose, amylase, triglycerides as needed
  • Set limits for maximal dilutions of elevated tests such as enzymes


  • DIC Panel – quantitative D-Dimer replaced FDP & SFMC
  • Standardized heparin protocol based on dosage based on body weight results in a decreased number of bleeding episodes due to heparin overdose
  • Continuously review hematology analyzer rules to reduce manual diff rate below 30%
  • Replace manual reticulocyte with automated counts
  • Implement Protime autoverification for outpatients
  • Discontinue bleeding time
  • Discontinue band neutrophil counts
  • Discontinue RBC folate testing
  • Encourage physicians to routinely order CBC instead of CBC with diff
  • Encourage physicians to order urinalysis with automatic reflex to microscopic exam if positive for blood, protein or leukocyte esterase
  • Implement urinalysis autoverification
  • Do not perform Protein C & S for patients receiving warfarin


  • Discontinue rapid bacterial antigen tests
  • Change diarrhea work-up from full O&P to Giardia antigen for outpatients & C.difficile for inpatients who develop diarrhea >3 days after admission
  • Decrease incubation time for urine cultures from 48 to 24 hours
  • Reflex HCV EIA positive specimens to TaqMan RT PCR instead of RIBA
  • Convert Chlamydia trachomatis (CT) and Neisseria gonorrheae (NG) testing to amplified test to increase detection rate by at least 1%
  • Introduce chlorhexidene skin preparation to reduce blood culture contamination rate below 1.5%
  • Delete Epstein Barr virus early antigen from EBV panel
  • Discontinue Sabaroud slant from initial fungal culture setup
  • Convert viral cultures to real time PCR
  • Convert Group B Strep to real time PCR
  • Discourage rapid Strep test and throat culture if physician intends to treat the patient regardless of the result
  • Discourage ordering of urine culture for nonrecurring uncomplicated urinary tract infections in nonpregnant women
  • Discourage fecal leukocyte testing and gram stains
  • Do not allow HIV PCR or Western Blot for screening
  • Encourage Neisseria PCR on urine for males with urethritis

Flow Cytometry

  • Publish criteria for appropriate use
  • Replace commercial lyse solution with homebrew solution
  • Eliminate Flow isotype control reagents
  • Discontinue daily normal controls on immune panels

Reference Laboratory

  • Reference Laboratory send-out tests monitored by pathologists
  • HCV genotyping brought in house
  • Cystic Fibrosis Screen brought in house

Hospital transfusion service

Recipient testing

  • Use immediate spin crossmatch or electronic crossmatch
  • Use of anti-IgG instead of polyspecific AHG
  • Perform elutions on DAT positive samples only if transfused within last 3 months
  • Eliminate recipient anti-A,B testing
  • Eliminate autocontrol
  • Eliminate weak D testing
  • Eliminate reading antibody screen after immediate spin
  • Eliminate antigen typing for clinically insignificant antibodies

Donor testing policies

  • Use anti-A,B to confirm group O units instead of separate anti-A and anti-B
  • Confirm Rh type only on Rh negative units

Cord blood

  • Perform ABO & Rh typing only if mom is group O or Rh negative
  • Don’t do elution if DAT is positive

Introduce thawed plasma policy to decrease Fresh Frozen Plasma wastage

Monitor surgeon specific transfusion data annually

Discontinue shed blood collection after open heart surgery

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