ASCP Releases New Choosing Wisely Recommendations

Sep 25, 2018

ASCP has 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 25 recommendations and is designed to support conversations between patients and physicians about what care is really necessary.

ASCP’s new Choosing Wisely recommendations include:

  1. Don’t request just a serum creatinine to test adult patients with diabetes and/or hypertension for CKD; use the Kidney Profile (serum Creatinine with eGFR and urinary albumin-creatinine ratio.)
  2. Don’t transfuse plasma to correct a laboratory value; treat the clinical status of the patient.
  3. Don’t order IgM antibody serologic studies to assess for acute infection with infectious agents no longer endemic in the US, and in general avoid using IgM antibody serologies to test for acute infection in the absence of sufficient pre-test probability.
  4. Do not perform peripheral blood flow cytometry to screen for hematological malignancy in the settings of mature neutrophilia, basophilia, erythrocytosis, thrombocytosis, isolated anemia, or isolated thrombocytopenia.
  5. Don’t perform Procalcitonin testing without an established, evidence-based protocol.

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.

“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,” said Dr. Hilborne. “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. “With its fifth Choosing Wisely list, ASCP continues to demonstrate dedication and leadership in helping pathologists and laboratory professionals engage in a dialogue about what care is best and what can be done to reduce overuse in our health care system.”

More than 80 specialty medical societies have joined the Choosing Wisely campaign since its inception in April 2012. To date, 590 recommendations regarding tests and procedures to question have been released as part of the campaign, and the specialty societies have undertaken considerable efforts to share the recommendations with their collective memberships.

Learn more about ASCP’s involvement in Choosing Wisely here.