ASCP released a new list of recommendations for laboratory tests that are commonly ordered but not always appropriate in pathology and laboratory medicine as part of the Choosing Wisely campaign, an initiative of the ABIM Foundation. The new list of five targeted, evidence-based recommendations expands ASCP’s existing list to 20 recommendations and is designed to support conversations between patients and physicians about what care is really necessary.
ASCP’s new Choosing Wisely recommendations include:
Do not order a frozen section on a pathology specimen if the result will not affect immediate (i.e., intraoperative or perioperative) patient management.
Do not repeat hemoglobin electrophoresis (or equivalent) in patients who have a prior result and who do not require therapeutic intervention or monitoring of hemoglobin variant levels.
Do not test for Protein C, Protein S, or Antithrombin III (ATIII) levels during an active clotting event to diagnose a hereditary deficiency because these tests are not analytically accurate during an active clotting event.
Do not order red blood cell folate levels at all. In adults, consider folate supplementation instead of serum folate testing in patients with macrocytic anemia.
Do not use sputum cytology to evaluate patients with peripheral lung lesions.
The expanded recommendations were developed under the leadership of Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)CM, Chair of ASCP’s Effective Test Utilization Steering Committee and a Past President of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance.
“ASCP is honored to be part of this important quality initiative,” said Dr. Hilborne. “As ASCP continues to expand our recommendations, we expect to see increasing higher quality, appropriate care with lower costs, and more effective use of our medical laboratory resources and personnel. Choosing Wisely aims to encourage clinician and patient conversations across all disciplines of medicine. ASCP’s work focuses on highlighting potentially unnecessary and sometimes harmful care in pathology and laboratory medicine.”
Examples of inappropriate and overutilized tests are frequent throughout both anatomic and clinical pathology and laboratory medicine. The medical laboratory tests targeted in the new ASCP recommendations were selected because they are tests that are commonly performed; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality patient care; and eliminating it or changing to another test is within the control of the clinician.
“Conversations about what care patients truly need is a shared responsibility among all members of the health care team,” said Richard J. Baron, MD, president and CEO of the ABIM Foundation. “ASCP’s new Choosing Wisely list will help pathologists and laboratory professionals across the country engage in a dialogue about what care is best and what we can do to reduce waste and overuse in our health care system.”
More than 75 specialty medical societies have joined the Choosing Wisely campaign since its inception in April 2012. To date, 520 tests and procedures to question have been released as part of the campaign, and the specialty societies are now undertaking considerable efforts to share the recommendations with their collective memberships. Consumer Reports creates patient friendly material on these recommendations and has covered more than 100 of these tests and procedures. This includes two reports on items from ASCP’s previous lists on Vitamin D Testing and Lab Tests before Surgery. These reports can be found here.
Download a guide to all 20 recommendations here. Learn more about ASCP’s involvement in Choosing Wisely here.