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Test Utilization Proposal for Reflex Bilirubin Testing: Why Order Two Tests When One Will Do?

Brooke M Katzman1, Brad S Karon1

  • 1Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.

The Journal of Applied Laboratory Medicine
|January 17, 2021
PubMed
Summary
This summary is machine-generated.

Implementing reflex testing for direct (conjugated) bilirubin (DB) when total bilirubin (TB) is elevated could significantly reduce unnecessary laboratory tests. Most bilirubin tests ordered stat show normal results, indicating potential for cost savings and efficiency gains.

Keywords:
Direct bilirubinReflex testingTest utilizationTotal bilirubin

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Diagnostic Testing

Background:

  • Direct (conjugated) bilirubin (DB) and total bilirubin (TB) are frequently ordered concurrently.
  • Current laboratory practices often involve simultaneous ordering of DB and TB tests.
  • Reflex testing algorithms can optimize laboratory test utilization.

Purpose of the Study:

  • To assess the feasibility and impact of implementing a reflex testing strategy for DB based on elevated TB levels.
  • To evaluate the potential reduction in unnecessary DB testing.
  • To analyze the patterns of DB and TB test ordering in a stat laboratory setting.

Main Methods:

  • Retrospective review of stat laboratory test orders for DB and TB from January to April 2017.
  • Categorization of 4828 test orders based on normal/high results for DB and TB.
  • Calculation of order percentages and median test results for each category.

Main Results:

  • A total of 4296 stat orders (89%) included both DB and TB tests.
  • The majority of orders (87.3%) showed normal results for both DB and TB.
  • Only 12.7% of orders had at least one abnormal bilirubin result.

Conclusions:

  • Most stat bilirubin tests for emergency and hospitalized patients fall within the normal reference range.
  • A reflex testing approach for DB, triggered by elevated TB, could prevent a substantial number of DB tests.
  • This strategy holds potential for improving laboratory efficiency and reducing costs.