Empirical ordering of stains in cytology-are we saving or losing?

Bronchoalveolar lavage (BAL) and body cavity fluids (pleural and peritoneal) have a useful role in the detection of infectious diseases, especially when combined with ancillary stains (Grocott methenamine silver, acid-fast bacilli, Fite, and cytomegalovirus). However, empirical ordering of stains and duplicate testing by concurrent microbiology cultures leads to unnecessary wastage of resources. The aim of our study was to optimize the use of resources.

We performed a retrospective review of all BALs and body cavity fluids from 2016 to 2018 to determine the baseline stain order rate, which was then used in conjunction with clinical information to create a reasonable target for 2019. The methods implemented included communication with the clinical team to modify current ordering practice, monitoring stain orders prospectively through 2019, and updating the cytology requisition form to limit upfront ordering of ancillary stains.

From 2016 to 2018, of the 1270 specimens reviewed, 323 (55%) were BALs and 108 (16%) were body cavity fluids that had had ≥2 stains preordered. This was reduced by the end of 2019 to 10% of BALs and 3.4% of body cavity fluids, leading to $25,935.24 in costs savings (including 275 hours of technician time and 39.3 hours of pathologist time).

We found that ancillary microorganism stains have limited utility in cytology specimens and should only be ordered when indicated after a review of the initial smears. In today's era of cost savings, upfront ordering of ancillary stains can lead to significant wastage of resources that can be prevented by improving workflow.