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Appropriateness of laboratory tests: requests for atypical pneumonia serology in a teaching hospital
L M Jackson1, F Shanahan, B Cryan
1Department of Medicine, Cork University Hospital, Wilton, Ireland.
Abstract:
The cost of providing medical care is ever-increasing but the resources available are at best static. Major savings can be made by reducing inappropriate investigations. Using serological testing for organisms causing atypical pneumonia as an example, we examined the appropriateness of requests and also physicians' understanding of the test. Of 119 patients tested, only 3 had titres indicative of acute infection. Most patients were tested within 2 days of hospital admission, before receipt of results excluding more likely diagnoses. Forty-five patients had no current or recent respiratory symptoms, in whom infection was highly unlikely. Titres were most often requested by the least experienced members of the clinical team. Of 70 patients with an acute illness in whom a definitive diagnosis, bacteriological or otherwise, was not made, in only 9 was a convalescent specimen sent for follow-up titres. Most requests for serology for organisms causing atypical pneumonia were inappropriate. Furthermore, in the majority of cases the test was incorrectly used.
Insights
Most serological tests for atypical pneumonia are inappropriately requested and misused by physicians. This leads to unnecessary medical investigations and increased healthcare costs, highlighting a need for better diagnostic test utilization.
Area of Science:
- Medical Diagnostics
- Infectious Diseases
- Healthcare Management
Background:
- Rising healthcare costs necessitate optimizing resource allocation.
- Reducing inappropriate medical investigations is key to cost savings.
- Serological testing for atypical pneumonia is a common but potentially overused diagnostic tool.
Purpose of the Study:
- To evaluate the appropriateness of serological testing requests for atypical pneumonia.
- To assess physicians' understanding and correct utilization of these tests.
- To identify areas for improving diagnostic test efficiency in clinical practice.
Main Methods:
- Retrospective review of 119 patient cases undergoing serological testing for atypical pneumonia.
- Analysis of request appropriateness based on clinical symptoms and diagnostic timing.
- Assessment of physician knowledge regarding test indications and interpretation.
Main Results:
- Only 3 out of 119 patients showed titres indicative of acute infection.
- 45 patients lacked respiratory symptoms, making infection unlikely.
- Most tests were requested within 2 days of admission, often before other diagnoses were excluded.
- Convalescent specimens for follow-up titres were rarely sent (9 out of 70).
- Tests were frequently requested by less experienced clinicians.
Conclusions:
- A significant majority of atypical pneumonia serology requests were inappropriate.
- Physicians often misused these diagnostic tests, indicating a need for improved education and guideline adherence.
- Optimizing the use of serological tests can lead to substantial healthcare cost savings.