Abstract
BACKGROUND: Diagnostic error is extremely common in the USA and likely around the world. A major reason for the diagnostic error is both the overutilization and the underutilization of laboratory tests. Using a panel of two to four experts in coagulation, test selection was reviewed in clinical context and in real time, and consensus determinations were made to derive conclusions about the extent of overutilization and underutilization.
METHODS: Two hundred cases of patients being evaluated for bleeding or thrombotic issues were presented at each daily meeting of the diagnostic management team, and a review of each case for appropriate utilization of tests was completed.
RESULTS: Two hundred randomly selected cases revealed 77.5% diagnostic errors (155 cases). Sixteen percent were associated with overutilization of laboratory tests, 44% were associated with underutilization, and 17.5% were associated with both. The annual cost burden estimated for overutilization alone in one institution of 450 beds was on the order of $20,000. The cost burden for the delay in diagnosis or the misdiagnosis in cases with underutilization is orders of magnitude greater ($200,000 or more), but it is impossible to determine the cost of a misdiagnosis in an individual case because it can produce many different clinical outcomes.
CONCLUSIONS: This was a rare opportunity for experts in a given field to review cases in real time and in clinical context and provide immediately a consensus answer about test utilization. The results of this study show errors in test selection in nearly 75% of the cases evaluated.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 21-26 |
| Number of pages | 6 |
| Journal | Diagnosis (Berlin, Germany) |
| Volume | 4 |
| Issue number | 1 |
| DOIs | |
| State | Published - Mar 1 2017 |
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Keywords
- coagulation
- laboratory test selection
- overutilization
- underutilization
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Health Policy
- Public Health, Environmental and Occupational Health
- Clinical Biochemistry
- Biochemistry, medical
Cite this
An assessment of overutilization and underutilization of laboratory tests by expert physicians in the evaluation of patients for bleeding and thrombotic disorders in clinical context and in real time. / Sarkar, Mayukh K.; Botz, Chad M.; Laposata, Michael.
In: Diagnosis (Berlin, Germany), Vol. 4, No. 1, 01.03.2017, p. 21-26.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - An assessment of overutilization and underutilization of laboratory tests by expert physicians in the evaluation of patients for bleeding and thrombotic disorders in clinical context and in real time
AU - Sarkar, Mayukh K.
AU - Botz, Chad M.
AU - Laposata, Michael
PY - 2017/3/1
Y1 - 2017/3/1
N2 - BACKGROUND: Diagnostic error is extremely common in the USA and likely around the world. A major reason for the diagnostic error is both the overutilization and the underutilization of laboratory tests. Using a panel of two to four experts in coagulation, test selection was reviewed in clinical context and in real time, and consensus determinations were made to derive conclusions about the extent of overutilization and underutilization.METHODS: Two hundred cases of patients being evaluated for bleeding or thrombotic issues were presented at each daily meeting of the diagnostic management team, and a review of each case for appropriate utilization of tests was completed.RESULTS: Two hundred randomly selected cases revealed 77.5% diagnostic errors (155 cases). Sixteen percent were associated with overutilization of laboratory tests, 44% were associated with underutilization, and 17.5% were associated with both. The annual cost burden estimated for overutilization alone in one institution of 450 beds was on the order of $20,000. The cost burden for the delay in diagnosis or the misdiagnosis in cases with underutilization is orders of magnitude greater ($200,000 or more), but it is impossible to determine the cost of a misdiagnosis in an individual case because it can produce many different clinical outcomes.CONCLUSIONS: This was a rare opportunity for experts in a given field to review cases in real time and in clinical context and provide immediately a consensus answer about test utilization. The results of this study show errors in test selection in nearly 75% of the cases evaluated.
AB - BACKGROUND: Diagnostic error is extremely common in the USA and likely around the world. A major reason for the diagnostic error is both the overutilization and the underutilization of laboratory tests. Using a panel of two to four experts in coagulation, test selection was reviewed in clinical context and in real time, and consensus determinations were made to derive conclusions about the extent of overutilization and underutilization.METHODS: Two hundred cases of patients being evaluated for bleeding or thrombotic issues were presented at each daily meeting of the diagnostic management team, and a review of each case for appropriate utilization of tests was completed.RESULTS: Two hundred randomly selected cases revealed 77.5% diagnostic errors (155 cases). Sixteen percent were associated with overutilization of laboratory tests, 44% were associated with underutilization, and 17.5% were associated with both. The annual cost burden estimated for overutilization alone in one institution of 450 beds was on the order of $20,000. The cost burden for the delay in diagnosis or the misdiagnosis in cases with underutilization is orders of magnitude greater ($200,000 or more), but it is impossible to determine the cost of a misdiagnosis in an individual case because it can produce many different clinical outcomes.CONCLUSIONS: This was a rare opportunity for experts in a given field to review cases in real time and in clinical context and provide immediately a consensus answer about test utilization. The results of this study show errors in test selection in nearly 75% of the cases evaluated.
KW - coagulation
KW - laboratory test selection
KW - overutilization
KW - underutilization
UR - http://www.scopus.com/inward/record.url?scp=85014364375&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85014364375&partnerID=8YFLogxK
U2 - 10.1515/dx-2016-0042
DO - 10.1515/dx-2016-0042
M3 - Article
C2 - 29536907
AN - SCOPUS:85014364375
VL - 4
SP - 21
EP - 26
JO - Diagnosis
JF - Diagnosis
SN - 2194-8011
IS - 1
ER -