Effectiveness of Practices to Support Appropriate Laboratory Test Utilization

Matthew Rubinstein, Robert Hirsch, Kakali Bandyopadhyay, Bereneice Madison, Thomas Taylor, Anne Ranne, Millie Linville, Keri Donaldson, Felicitas Lacbawan, Nancy Cornish

Research output: Contribution to journalReview articlepeer-review

58 Scopus citations


Objectives To evaluate the effectiveness of practices used to support appropriate clinical laboratory test utilization. Methods This review followed the Centers for Disease Control and Prevention (CDC) Laboratory Medicine Best Practices A6 cycle method. Eligible studies assessed one of the following practices for effect on outcomes relating to over- or underutilization: computerized provider order entry (CPOE), clinical decision support systems/tools (CDSS/CDST), education, feedback, test review, reflex testing, laboratory test utilization (LTU) teams, and any combination of these practices. Eligible outcomes included intermediate, systems outcomes (eg, number of tests ordered/performed and cost of tests), as well as patient-related outcomes (eg, length of hospital stay, readmission rates, morbidity, and mortality). Results Eighty-three studies met inclusion criteria. Fifty-one of these studies could be meta-analyzed. Strength of evidence ratings for each practice ranged from high to insufficient. Conclusion Practice recommendations are made for CPOE (specifically, modifications to existing CPOE), reflex testing, and combined practices. No recommendation for or against could be made for CDSS/CDST, education, feedback, test review, and LTU. Findings from this review serve to inform guidance for future studies.

Original languageEnglish (US)
Pages (from-to)197-221
Number of pages25
JournalAmerican journal of clinical pathology
Issue number3
StatePublished - Feb 17 2018

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine


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