title: Urine cytology: appropriate usage maximizes sensitivity and reduces cost.
abstract: OBJECTIVE
  Urine cytology is costly because of the skilled manpower required for analysis. Inappropriate requests are a significant drain both financially and on the cytopathologist's time. The present study aimed at identifying the extent and cause of this misuse and reduce it.
  
  
  METHODS
  An audit of urine cytology usage was undertaken using the hospital results reporting system to identify requests. Patient case notes were then obtained to gain further clinical information. Initially a 2-week period was analysed, following which departmental guidelines for requesting urine cytology were produced and circulated. The audit loop was then closed.
  
  
  RESULTS
  Over the initial 2-week period, 117 urine cytology requests were received. Thirty-three per cent were inappropriate, either because they were from patients with benign disease or because of duplication. Following the education programme this number fell to 6%. Expenditure on unnecessary samples thus decreased from pounds 2418 to only pounds 310, giving an annual overall saving of pounds 55,000.
  
  
  CONCLUSIONS
  Significant cost and time savings can be made if urine cytology is sent appropriately. Simple guidelines and staff education are the key to reducing inefficiency. Our findings have implications not just for cytopathology costs but for laboratory and radiology requests in general.
authors.affiliation: Department of Urology, Guy's and St Thomas' NHS Trust, London, UK. darrell34a@hotmail.com
authors.forename: D J
authors.initials: DJ
authors.lastname: Allen
authors.forename: B
authors.initials: B
authors.lastname: Challacombe
authors.forename: J S
authors.initials: JS
authors.lastname: Clovis
authors.forename: A
authors.initials: A
authors.lastname: Chandra
authors.forename: P
authors.initials: P
authors.lastname: Dasgupta
authors.forename: R
authors.initials: R
authors.lastname: Popert
mesh_terms: D017048:Health Care Costs; D006801:Humans; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000191:economics*; D014556:Urine / Q000166:cytology*