Clinical pathology selected abstracts

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Correspondence: Dr. Jeffrey Goldsmith at jeffrey.goldsmith@childrens.harvard.edu

Simple lab test utilization interventions to reduce inappropriate specialty coagulation testing

Coagulation factor assays are commonly ordered laboratory tests for assessing coagulopathy. The more common of the prolonged screening assays, prothrombin time (PT) and activated partial thromboplastin time (aPTT), are used to predict bleeding disorders or increased risk for bleeding. These and other factor activity assays are available at most specialized coagulation reference laboratories. The factors are named with the Roman numerals I, II, V, VII, VIII, IX, X, XI, XII, and XIII. This may cause confusion among clinicians using the electronic ordering systems and result in inappropriate test orders, which, in turn, may delay results and lead to unnecessary test ordering. The authors conducted a study to assess utilization before and after interventions for the specialty coagulation assays factor V and factor X. They implemented the simple but important interventions of changing the test names from factor assay to factor activity and having pathology residents review all factor V and X requests. They performed a retrospective review of factor V and X activity orders for one year before and one year after interventions. Prior to their interventions, the authors had noticed several inappropriate orders due to clinicians’ confusion regarding ordering factor V and X activities versus factor V Leiden mutational analysis and the anti-Xa assay, respectively. The authors found that after the interventions, factor V and X activity orders decreased by approximately 40 percent. This resulted in test volume decreases for factor V (53.8 percent) and factor X (47.8 percent), which produced savings of $2,493.05 and $1,867.80 per year, respectively. They also noted that factor V activity orders from outpatient clinics decreased by 21.6 percent. The authors concluded from their study that focused and systemic interventions, such as name changes in the electronic ordering system and pathology utilization review, can reduce inappropriate test ordering and unnecessary laboratory costs for factor V and X activity.

Huang H, Cunningham AM, Harrington AM. Simple laboratory test utilization interventions to reduce inappropriate specialty coagulation testing. Am J Clin Pathol. 2020;153(2):181–189.

Correspondence: Dr. Alexandra M. Harrington at aharring@mcw.edu