title: Impact of add-on laboratory testing at an academic medical center: a five year retrospective study.
abstract: BACKGROUND
  Clinical laboratories frequently receive orders to perform additional tests on existing specimens ('add-ons'). Previous studies have examined add-on ordering patterns over short periods of time. The objective of this study was to analyze add-on ordering patterns over an extended time period. We also analyzed the impact of a robotic specimen archival/retrieval system on add-on testing procedure and manual effort.
  
  
  METHODS
  In this retrospective study at an academic medical center, electronic health records from were searched to obtain all add-on orders that were placed in the time period of May 2, 2009 to December 31, 2014.
  
  
  RESULTS
  During the time period of retrospective study, 880,359 add-on tests were ordered on 96,244 different patients. Add-on testing comprised 3.3 % of total test volumes. There were 443,411 unique ordering instances, leading to an average of 1.99 add-on tests per instance. Some patients had multiple episodes of add-on test orders at different points in time, leading to an average of 9.15 add-on tests per patient. The majority of add-on orders were for chemistry tests (78.8 % of total add-ons) with the next most frequent being hematology and coagulation tests (11.2 % of total add-ons). Inpatient orders accounted for 66.8 % of total add-on orders, while the emergency department and outpatient clinics had 14.8 % and 18.4 % of total add-on orders, respectively. The majority of add-ons were placed within 8 hours (87.3 %) and nearly all by 24 hours (96.8 %). Nearly 100 % of add-on orders within the emergency department were placed within 8 hours. The introduction of a robotic specimen archival/retrieval unit saved an average of 2.75 minutes of laboratory staff manual time per unique add-on order. This translates to 24.1 hours/day less manual effort in dealing with add-on orders.
  
  
  CONCLUSIONS
  Our study reflects the previous literature in showing that add-on orders significantly impact the workload of the clinical laboratory. The majority of add-on orders are clinical chemistry tests, and most add-on orders occur within 24 hours of original specimen collection. Robotic specimen archival/retrieval units can reduce manual effort in the clinical laboratory associated with add-on orders.
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 USA.
authors.forename: Louis S
authors.initials: LS
authors.lastname: Nelson
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Davis
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Humble
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Kulhavy
authors.affiliation: Hospital Computing Information Services, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 USA.
authors.forename: Dean R
authors.initials: DR
authors.lastname: Aman
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Krasowski
keywords: Clinical chemistry tests; Clinical laboratory information services; Clinical laboratory services; Hematology; Laboratory automation; Robotics