Variation in laboratory tests ordered for patients treated in hospital emergency departments

Salinas M, López-Garrigós M, Uris J, Leiva-Salinas C

Objective: To compare laboratory test request patterns for patients treated in Spanish hospital emergency departments.

Methods: We studied the number of laboratory tests ordered for patients treated in 76 hospital emergency departments in 2012. We calculated the number of times each test was ordered per 1000 patients and the frequency ratios between certain related tests. The ratios were compared with targets (aspartate aminotransferase [AST]/alanine aminotransferase [ALT], 0.25; urea/creatinine, 0.1). Testing patterns were compared between hospitals grouped by type of administration, geographic location, and size.

Results: Variation in demand for the different tests was high between hospitals, especially for the less frequently ordered tests. Only 1 transaminase test was ordered in 12 hospitals (only ALT in 9 hospitals; only AST in 3 hospitals). Both lipase and amylase tests were ordered in half the hospitals. Creatine kinase testing was ordered more often than troponin

testing in most hospitals. Most of the hospitals also ordered urea and creatinine tests. A third of the hospitals did not test for either albumin or type B natriuretic peptide levels; a quarter of the hospitals did not order procalcitonin tests.

Conclusions: The pattern of laboratory testing, in relation to available tests, varies between emergency departments. Which tests contribute the most to emergency care management should be determined through better communication between emergency department physicians and laboratory staff so that clinical care protocols can be followed.

Leiva-Salinas C, López-Garrigós M, Salinas M, Uris J