Expanded Recommendations Part of Choosing Wisely® Campaign
Chicago, Feb. 3, 2015—The American Society for Clinical Pathology (ASCP) today released a new list of recommendations for laboratory tests that are commonly ordered but not always appropriate in pathology and laboratory medicine as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. The new list of five targeted, evidence-based recommendations expands ASCP’s original list released in February 2013 and is designed to support conversations between patients and physicians about what care is really necessary.
ASCP’s new Choosing Wisely® recommendations include:
- Don’t order an erythrocyte sedimentation rate (ESR) to look for inflammation in patients with undiagnosed conditions. Order a C-reactive protein (CRP) to detect acute phase inflammation.
- Don’t test vitamin K levels unless the patient has an abnormal international normalized ratio (INR) and does not respond to vitamin K therapy.
- Don’t prescribe testosterone therapy unless there is laboratory evidence of testosterone deficiency.
- Don’t test for myoglobin or CK-MB in the diagnosis of acute myocardial infarction (AMI). Instead, use troponin I or T.
- Don’t order multiple tests in the initial evaluation of a patient with suspected non–neoplastic thyroid disease. Order thyroid-stimulating hormone (TSH) and, if abnormal, follow-up with additional evaluation or treatment depending on the findings.
The expanded recommendations were developed under the leadership of Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)CM, Chair of ASCP’s Choosing Wisely Ad Hoc Committee, 2011–2012 Chair of the ASCP Institute Advisory Committee, and a Past President of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance.
“When implemented, these recommendations can result in higher quality care, lower costs, and more effective use of our medical laboratory resources and personnel,” noted Dr. Hilborne. “At its core, Choosing Wisely® aims to encourage clinician and patient conversations across all disciplines of medicine. ASCP’s work focuses on highlighting potentially unnecessary and sometimes harmful care in pathology and laboratory medicine.”
Examples of inappropriate and overutilized tests are pervasive throughout both anatomic and clinical pathology and laboratory medicine. The medical laboratory tests targeted in the new ASCP recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician.
“The insights we learned from the first round of recommendations have been very helpful,” added Dr. Hilborne. “Members have used the recommendations to foster discussions and training among their medical staff, clinical committees, and clinicians, which has truly helped drive appropriate test utilization in their institutions.”
Health care delivery in the United States currently contains practices that may provide little, if any, benefit to patients. Pathologists and laboratory professionals need to play a leadership role in addressing these challenges. A primary goal of the initiative is to avoid negative consequences associated with the overuse of medical services.
“At its heart, ASCP is a patient and member centered organization, and our main role in the Choosing Wisely® program is to make sure the laboratory is well represented in the appropriate utilization of medical resources,” said William G. Finn, MD, FASCP, President of ASCP. “The clinical lab is involved in an extraordinarily high percentage of medical decisions and, as such, plays a fundamental role in every patient’s health care. Choosing Wisely® enables ASCP to be part of reforming how resources are used to help patients in the most efficient and effective ways.”
“My biggest hope is that these recommendations are elevated to the system level and foster broader conversations to come to a consensus for how best to utilize laboratory tests more effectively,” continued Dr. Finn. “The potential for this is tremendous as it will help us limit overused tests and enable use of more appropriate tests. Even more importantly, it helps expand the role of pathologists and laboratory professionals as members of the healthcare team making these critical decisions.”
More than 65 specialty medical societies have joined the Choosing Wisely® campaign since its inception in April 2012. To date more than 330 tests and procedures to question have been released as part of the campaign, and the specialty societies are now undertaking considerable efforts to share the recommendations with their collective memberships.
Founded in 1922 in Chicago, ASCP is a medical professional society with more than 100,000 member board-certified anatomic and clinical pathologists, pathology residents and fellows, laboratory professionals, and students. ASCP provides excellence in education, certification, and advocacy on behalf of patients, pathologists, and laboratory professionals. To learn more, visit www.ascp.org. Follow us on Twitter at www.twitter.com/ascp_chicago and connect with us on Facebook at www.facebook.com/ASCP.Chicago.