Appropriate laboratory test utilization to enhance patient safety and reduce waste
Laboratory shortages of blood tubes, syringes, collection needles and more
How can primary care providers and hospitals manage utilization to help with current laboratory shortages? See the latest guidelines below.
Read a related story in the Ottawa Citizen Beriault and Weinerman: Shortage of lab supplies plagues many Canadian hospitals
Efficient and appropriate laboratory utilization can help improve stewardship of limited resources and contribute to patient safety. Additionally, fewer unnecessary tests may reduce testing demand and decrease healthcare costs associated with laboratory testing. To achieve this, it is essential to minimize the amount of inappropriate or redundant testing orders placed by physicians.
We are evaluating the appropriateness of testing in several areas of Laboratory Medicine, starting with the top 10 popular order sets.
Concurrently, we are sharing methodology across disciplines, reviewing various materials (communications, patient support documents), and initiating collaboration with colleagues from other departments.
Latest guidelines from the laboratory test utilization working group
Global Blood Collection Tube Shortage
Disruptions in global supply chains due to COVID-19 have resulted in global supply constraints related to bloodcollection tubes. Supply constraints for blood collection tubes are expected to stabilize in the coming months. However, current shortages are impacting all healthcare organizations and there is a need for immediate action to conserve tubes.
Suggested conservation strategies are below.
- Do not order non-essential laboratory tests; critically assess the potential for a test result to impact immediate patient care before ordering.
- Avoid blood work in stable or asymptomatic outpatients.
- Avoid blood work in alternate level of care patients.
- Do not order routine standing orders and consider cancelling unnecessary standing orders.
- Do not perform annual screening blood tests unless directly indicated by the risk profile of the patient.
- Consider reviewing or pausing medical directives, order sets and order panels in clinical areas where blood work is drawn routinely (e.g. Emergency Department).
- Refer to Choosing Wisely Canada recommendations (below) for appropriate test utilization guidance for specific clinical situations.
- Laboratory medicine departments should consider validation of alternative blood collection tubes and supplies.
- Consider reviewing blood draw practices with local stakeholders to identify opportunities to reduce blood draws.
- Consider partnering with local laboratories to share supplies and off-set respective critical shortages.
- Review previous laboratory test results including point-of-care test results that may have already included the test of interest, for e.g., glucose meter checks and electrolytes on blood gas analyzers.
- Whenever possible, add-on tests to existing blood draws.
For Phlebotomists and Laboratorians
- Follow laboratory guidelines on grouping tests on single tubes to make the most efficient use of tubes and collection.
- Engage with local laboratory medicine and procurement teams to gain awareness of the status of supplies, recommended usage, and validated alternatives.
- Ask your hospital or community laboratory for clarification on unnecessary tests and procedures.
- Connect with your local data analytics team to consider feasibility of development of a blood collection tube dashboard to best track supply and demand, send alerts, help inform the feasibility and safety of clinical care ramp up based on blood tube availability.
Other resources: Choosing Wisely Canada
- Ontario Association of Medical Laboratories
- Choosing Wisely Canada
- Ontario Association of Medical Laboratories
- Canadian Society of Clinical Chemists (CSCC)
- Canadian Association of Medical Biochemists (CAMB)
View an update from the project team
Other working groups of interest
The Canadian Society of Clinical Chemists (CSCC) Utilization Management Interest Group aims to share best practices for laboratory utilization management among other laboratories, develop recommendations for laboratory utilization management, and promote optimal laboratory utilization among laboratory users.
Other available guidelines
Dr. Dan Beriault has led a national working group with Choosing Wisely Canada to produce utilization recommendations aimed at helping to deal with the severe shortages that clinical labs are facing (blood tubes, syringes, collection needles etc.).
- Recommendations for conserving lab resources in primary care (PDF)
- Recommendations for conserving lab resources in hospitals (PDF)
Relevant publications for further information
These will be added soon.