The timely, clinically appropriate use of laboratory tests is a singular challenge in laboratory medicine. The Directory of Services of a large hospital or commercial laboratory lists hundreds of tests, placing a dizzying array of diagnostic tools at the disposal of the clinician. And often, the clinician is left without clear guidance in the utility of many of these tests – or worse yet, is confronted by aggressive marketing by the manufacturers of newer, faster testing procedures and analytes.

While underutilization of tests can miss important diagnostic markers, overutilization drives health care costs ever-higher. More importantly, it must be borne in mind that, even in individuals with no clinical symptoms indicative of a disease, using lab tests to simply "rule out" this – or – that condition can still produce test results in a critical range. This in turn can lead to further patient mismanagement and unnecessarily drive testing costs to exorbitant levels.

In order to avoid malutilization of lab testing, we need to consider some basic factors:

One factor to consider is likelihood. For example, while it may be necessary to do a PSA assay on a male patient presenting with symptoms, it is not necessary to also run a CA-125, since this is a marker for ovarian cancer. The clinical presentation ("male") eliminates the need to rule out a tumor than has a near-zero chance of being present.

Another factor to consider is frequency. For any given conditions, there are sequela of events that take place at certain times in disease progression. To order lab tests too frequently is expensive and lacks clinical relevance, while ordering them irregularly or too infrequently can give false impressions (e.g., analyte "spikes" that don't exist, a lack of resolution of disease in spite of treatment) that mask clinically relevant changes in a patient's status.

Without considering these and other important factors in determining appropriate lab tests for the patients we serve, we risk making expensive, clinically irrelevant choices that serve neither our patients nor our budgetary obligations.

It is important for the clinical laboratory to be empowered to guide and educate physicians in the proper use of lab tests. The lab should provide appropriate guidelines, time intervals, test ranges, critical values, and so on to the clinician, who may not be aware of the ever-increasing numbers of tests or their indications for use. Only by making these elements clear in an ongoing partnership between clinicians and lab personnel can optimal lab test utilization be achieved. In so doing, we maximize the benefit to the patient and drive down the often staggering costs of overutilization.

Let Ektelligen help you create those critical relationships. We can help you craft educational materials, letters, and other business communications that will allow you to create strong, trusting partnerships between your lab staff and clinicians. In so doing you will maximize proper test utilization, optimizing patient care and maximizing value for dollar spent. Contact an Ektelligen representative today!