{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,3,2]],"date-time":"2024-03-02T14:08:47Z","timestamp":1709388527751},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>An evolving COVID-19 testing landscape and issues with test supply allocation, especially in the current pandemic, has made it challenging for ordering providers. We audited orders of the Xpert\u00ae Xpress SARS-CoV-2 PCR with reverse transcription (RT\u2013PCR) platform\u2014the fastest of several other testing modalities available\u2014to illuminate these challenges utilizing a multidisciplinary laboratory professional team consisting of a pathology resident and microbiology laboratory director.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective review of the first 5 hundred Xpert Xpress SARS-CoV-2 RT\u2013PCR test orders from a 2-week period to determine test appropriateness based on the following indications: emergency surgery, emergent obstetric procedures, initial behavioral health admission, and later including discharge to skilled care facilities and pediatric admissions. Our hypothesis was that a significant proportion of orders for this testing platform were inappropriate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>On review, a significant proportion of orders were incorrect, with 69.8% (n\u2009=\u2009349, P\u2009&amp;lt;\u20090.0001) not meeting indications for rapid testing. Of all orders, 249 designated as emergency surgery were inappropriate, with 49.0% of those orders never proceeding with any surgical intervention; most of these were trauma related (64.6% were orders associated with a trauma unit).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Significant, pervasive inappropriate ordering practices were identified at this center. A laboratory professional team can be key to identifying problems in testing and play a significant role in combating inappropriate test utilization.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jalm\/jfab081","type":"journal-article","created":{"date-parts":[[2021,6,27]],"date-time":"2021-06-27T03:08:11Z","timestamp":1624763291000},"page":"1484-1491","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of Inappropriate COVID-19 RT\u2013PCR Test Utilization at an Academic Medical Center"],"prefix":"10.1093","volume":"6","author":[{"given":"Naomi L","family":"Hardy","sequence":"first","affiliation":[{"name":"Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul M","family":"Luethy","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"2021110213155971800_jfab081-B1","first-page":"15","article-title":"Towards better test utilization\u2014strategies to improve physician ordering and their impact on patient outcomes","volume":"26","author":"Freedman","year":"2015","journal-title":"EJIFCC"},{"key":"2021110213155971800_jfab081-B2","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1186\/s12913-019-4639-3","article-title":"Self-reported test ordering practices among Canadian internal medicine physicians and trainees: a multicenter cross-sectional survey","volume":"19","author":"Bodley","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2021110213155971800_jfab081-B3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.amsu.2020.02.002","article-title":"Inappropriate laboratory testing in internal medicine inpatients: prevalence, causes and interventions","volume":"51","author":"Vrijsen","year":"2020","journal-title":"Ann Med Surg (Lond)"},{"key":"2021110213155971800_jfab081-B4","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.cca.2013.09.022","article-title":"A perspective on laboratory utilization management from Canada","volume":"427","author":"Naugler","year":"2014","journal-title":"Clin Chim Acta"},{"key":"2021110213155971800_jfab081-B5","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/j.clinbiochem.2017.05.004","article-title":"Rates of inappropriate laboratory test utilization in Ontario","volume":"50","author":"Chami","year":"2017","journal-title":"Clin Biochem"},{"key":"2021110213155971800_jfab081-B6","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1001\/jama.280.6.565","article-title":"The need for an outcomes research agenda for clinical laboratory testing","volume":"280","author":"Lundberg","year":"1998","journal-title":"JAMA"},{"key":"2021110213155971800_jfab081-B7","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.clinbiochem.2017.03.002","article-title":"The role of laboratory in ensuring appropriate test requests","volume":"50","author":"Ferraro","year":"2017","journal-title":"Clin Biochem"},{"key":"2021110213155971800_jfab081-B8","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4300\/JGME-D-10-00021.1","article-title":"Educating physicians-in-training about resource utilization and their own outcomes of care in the inpatient setting","volume":"2","author":"Dine","year":"2010","journal-title":"J Grad Med Educ"},{"key":"2021110213155971800_jfab081-B9","doi-asserted-by":"crossref","first-page":"S172","DOI":"10.1093\/ajcp\/aqx149.386","article-title":"A clinical decision support alert prevents inappropriate repeat laboratory testing ordered within the same admission on inpatients","volume":"149","author":"Qavi","year":"2018","journal-title":"Am J Clin Pathol"},{"key":"2021110213155971800_jfab081-B10","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12911-020-01384-8","article-title":"Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems","volume":"21","author":"Zare","year":"2021","journal-title":"BMC Med Inform Decis Mak"},{"key":"2021110213155971800_jfab081-B11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.cca.2013.05.024","article-title":"Establishing benchmarks and metrics for disruptive technologies, inappropriate and obsolete tests in the clinical laboratory","volume":"427","author":"Kiechle","year":"2014","journal-title":"Clin Chim Acta"},{"key":"2021110213155971800_jfab081-B12","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1309\/AJCPX1HIEM4KLGNU","article-title":"Do we now know what inappropriate laboratory utilization is? An expanded systematic review of laboratory clinical audits","volume":"141","author":"Hauser","year":"2014","journal-title":"Am J Clin Pathol"},{"key":"2021110213155971800_jfab081-B13","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1177\/0310057X1804600309","article-title":"Strategies to reduce inappropriate laboratory blood test orders in intensive care are effective and safe: a before-and-after quality improvement study","volume":"46","author":"Dhanani","year":"2018","journal-title":"Anaesth Intensive Care"}],"container-title":["The Journal of Applied Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jalm\/advance-article-pdf\/doi\/10.1093\/jalm\/jfab081\/39456454\/jfab081.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jalm\/article-pdf\/6\/6\/1484\/41046950\/jfab081.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jalm\/article-pdf\/6\/6\/1484\/41046950\/jfab081.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,2]],"date-time":"2021-11-02T13:39:05Z","timestamp":1635860345000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jalm\/article\/6\/6\/1484\/6311660"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,30]]},"references-count":13,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,30]]},"published-print":{"date-parts":[[2021,11,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jalm\/jfab081","relation":{},"ISSN":["2576-9456","2475-7241"],"issn-type":[{"value":"2576-9456","type":"print"},{"value":"2475-7241","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,11,1]]},"published":{"date-parts":[[2021,6,30]]}}}