Valerie Neff Newitt
September 2025—Enrollment is underway now for a new CAP study that will make it possible for individual and integrated laboratories to compare inpatient analyte volumes and identify ordering practice problems.
“This study is the first by the CAP that will allow system laboratories to evaluate a quality metric—inpatient test utilization—across all laboratories within their system and in comparison to like system laboratories across the U.S. and beyond,” says Richard Brown, MD, former chair and now advisor to the CAP Quality Practices Committee, whose members developed the study.
The purpose of the study is to provide participants with comparative benchmarks of various annual inpatient test analyte volumes. “It normalizes a variety of commonly ordered tests to inpatient days—for example, the total number of troponin tests per total number of inpatient days—so that test utilization can be evaluated on an apples-to-apples basis,” says Dr. Brown, former medical director of system laboratory services, Memorial Hermann Health System, Houston. Laboratories that have utilization levels at the high or low end, based on the results of this study, should evaluate the comparative data they receive relative to their patient population.
“A hospital with a large population of cardiovascular patients may have much higher levels of troponin and BNP utilization than others,” Dr. Brown notes. “If an outlier cannot be explained based on demographics, additional investigation is warranted, including a determination of the most frequently ordering service lines and providers, and whether the test is part of a test panel or disease-specific order set.”
For laboratories in hospital systems, this study is the first to enable an expansive look at test use.
Quality Practices Committee chair Keri Donaldson, MD, MSCE, says understanding utilization patterns within and across systems “may allow us to better describe the quality impact of test utilization programs.”
“We think being able to better define the value of lab and test stewardship is important for all portions of the health care ecosystem,” says Dr. Donaldson, vice chair of clinical pathology and laboratory medicine, Geisinger Health System, Danville, Pa.
For CAP-accredited laboratories, participants in the study will be able to use its findings to meet accreditation program checklist requirements. The most direct application, Dr. Brown says, is to DRA.10700 Director Responsibility—Consultations, which requires the laboratory director to provide clinical consultations on the ordering of appropriate tests and the medical significance of laboratory data. “The data and analyses from this study seek to provide a framework for these discussions,” Dr. Brown says.
DRA.10440 Effective Quality Management System requires the laboratory director to ensure an effective QMS, and GEN.20316 QMS Indicators of Quality requires the QMS to include monitoring key indicators of quality in all testing phases from preanalytic to postanalytic. The monitored activities must be integral to patient care delivery. One of the possible indicators of quality listed and often used is an evaluation of test ordering practices, Dr. Brown says, “for which this study may provide supporting data and a template for future utilization studies.”
The study will be posted online Dec. 15 to provide time for review of the analyte selection and to coordinate the activity within a laboratory or for distribution within a system. It can be ordered through Jan. 30, 2026. The period during which analyte data must be collected and entered in the CAP’s eLab Solutions Suite is 10 weeks. The data will be based on 2025 or a recent 12-month period.
“We’re going to send the program out to a primary site for coordination,” Dr. Brown says. System laboratories will return data to the primary coordinating lab for entry. If a system distributes the result form to more than one of its laboratories, “they will receive comparative data as a summary report.” If 10 laboratories in a system participate, for example, “a summary-level report would compare all 10 of those sites against each other,” Dr. Brown says. With sufficient participation, like institutions across systems will be compared. Hospital laboratories that are not part of a system can also enroll. “There’s no requirement to be part of a system.”
For laboratories in the U.S., the cost to enroll is $506 (one to five laboratories). For six to 10 laboratories, the cost to enroll is $759. Multiple orders can be purchased to accommodate a larger number of sites.
The data collection time is a barrier for some, and to address that, “we have cut back on the number of questions we ask and the complexity of the analytes,” Dr. Brown says, referring to a 2020 inpatient test use and volume benchmarking study that was similar but did not enable comparisons by laboratories within integrated systems. “We always aim to balance trying to get meaningful information versus trying to make data collection as user-friendly as possible.”
Undertesting and overtesting will be evaluated, and the tests to be evaluated in the new study reflect changes in practice since the prior study.
Many laboratories today employ some form of laboratory stewardship, Dr. Brown says, judging from the 2020 study data and anecdotal discussion among Quality Practices Committee members.
“However, the spectrum of activity is broad, ranging from simple measures like IT programming that eliminates duplicate orders to multidisciplinary institutional committees that regularly evaluate test ordering practices and determine if and when new tests should be added to the inpatient formulary.” The questionnaire that is part of the new study will ask questions that were asked in 2020, “so trends in stewardship can be meaningfully evaluated.”
For example, questions asked in the 2020 study include, among others: Is the laboratory involved with review of the inpatient test menu? And is a mechanism in place such that laboratory staff can question a test order before it is run or alert a pathologist?
Laboratory testing stewardship programs vary. Committee chair Dr. Donaldson names three fundamental components: data access and analytics, test menu oversight, and a reporting structure to the medical and hospital leadership. “Part of the committee’s current efforts,” he says, “are aimed at better describing the extent and impact of test stewardship programs.”
The CAP’s Test Ordering Program can be of assistance to laboratories in their stewardship work. Generally, five new modules are added yearly, and the existing modules online are reviewed and updated, if needed, at least every three years. These analyte-specific modules can be used as models on how to investigate and intervene when problematic test-ordering practices are identified.
For information on the Test Ordering Program or to enroll in the new study (QPA5 and QPA10), go to https://capatholo.gy/413LGfq.
Valerie Neff Newitt is a writer in Audubon, Pa.