Evaluation of add-on testing in the clinical chemistry laboratory of a large academic medical center: operational considerations.
BACKGROUND
Physicians frequently request that additional tests be performed on an existing specimen (add-ons). In our institution, add-ons comprise approximately 1% of the specimen volume and require a disproportionate number of employees. Not only are add-on tests time-consuming and expensive, but storing routine specimens for 7 days in anticipation of add-ons consumes valuable laboratory space.


METHODS
One hundred sixty add-on tests during a 1-week period were reviewed.


OBJECTIVE
To analyze the pattern of add-on testing and determine methods to improve laboratory operations.


RESULTS
All add-on tests were ordered within 24 hours of receipt of the original specimen, even though specimens were retained for 7 days. At our institution, 1.5 full-time equivalents are required to complete add-on testing, which accounts for less than 1% of the specimen volume. The most common add-on tests recorded during the study period were hepatic and electrolyte/renal/glucose panels. The medicine service ordered more than 60% of the add-on tests. Five percent of add-on tests were caused by a lack of order communication, 64.7% of cardiac marker add-ons were not ordered according to the chest pain protocol, and certain ordering patterns were present.


CONCLUSIONS
Routine specimens do not need to be retained for 7 days to accommodate add-on tests. Decreasing the storage time to 2 days would save space, while still maintaining regulatory compliance. Order communication with the laboratory, educating physicians about chest pain protocols, and instituting admission laboratory panels would decrease the number of add-ons in our hospital. This change would translate into a reduction in laboratory expenses and an improvement in operations.
Division of Laboratory Medicine, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Stacy Foran
SF
Melanson
Brian
B
Hsieh
James G
JG
Flood
Kent B
KB
Lewandrowski
D000046:Academic Medical Centers / Q000458:organization & administration*; D001900:Boston; D019963:Clinical Chemistry Tests / Q000706:statistics & numerical data*; D002984:Clinical Laboratory Information Systems / Q000458:organization & administration / Q000706:statistics & numerical data*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational; D005568:Forms and Records Control; D006801:Humans; D007677:Kidney Function Tests / Q000706:statistics & numerical data; D007755:Laboratories, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D008111:Liver Function Tests / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013997:Time Factors; D016526:Workload