{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T16:50:43Z","timestamp":1784998243606,"version":"3.55.0"},"reference-count":32,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>Context.\u2014<\/jats:title>\n                    <jats:p>In the United States, approximately $65 billion dollars is spent per year on clinical laboratory testing, of which 20% to 30% of all testing is deemed inappropriate. There have been multiple studies in the field of transfusion medicine regarding evidence-based transfusion practices, but limited data exist regarding inappropriate pretransfusion testing and its financial and clinical implications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective.\u2014<\/jats:title>\n                    <jats:p>To assess duplicative testing practices in the transfusion medicine service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design.\u2014<\/jats:title>\n                    <jats:p>A 24-month retrospective review was performed at a 1025-bed tertiary care center, identifying all duplicate type and screen (TS) tests performed within 72 hours of the previous TS. Duplicative testing was classified as appropriate or inappropriate by predetermined criteria. The level of underordering was analyzed through a query of the electronic event reporting system. A cost analysis was performed to determine the financial impact of inappropriate duplicative TS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.\u2014<\/jats:title>\n                    <jats:p>The mean rate of inappropriate, duplicative TS orders was 4.13% (standard deviation \u00b1 4.09%). Rates of inappropriate ordering ranged from 0.01% to 15.5% depending on the clinical service and did not correlate with volume of tests ordered. There were 8 reported cases of delayed blood delivery due to lack of a valid TS during the study period, demonstrating that underordering is also a harmful practice. The laboratory cost of inappropriate testing for the study period was $80,434, and phlebotomy costs were $45,469.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.\u2014<\/jats:title>\n                    <jats:p>Our study demonstrates that inappropriate TS ordering is costly, both financially and clinically. By evaluating the percentage of inappropriate TS tests by clinical services, we have identified services that may benefit from additional education and technologic intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5858\/arpa.2016-0629-oa","type":"journal-article","created":{"date-parts":[[2017,12,6]],"date-time":"2017-12-06T10:29:01Z","timestamp":1512556141000},"page":"358-363","source":"Crossref","is-referenced-by-count":9,"title":["Duplicate Type and Screen Testing: Waste in the Clinical Laboratory"],"prefix":"10.5858","volume":"142","author":[{"given":"Margaret L.","family":"Compton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny C.","family":"Szklarski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett S.","family":"Booth","sequence":"additional","affiliation":[{"name":"From the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","published-online":{"date-parts":[[2017,12,6]]},"reference":[{"issue":"5","key":"2020081220045939700_i1543-2165-142-3-358-b01","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1093\/clinchem\/42.5.813","article-title":"Why is the laboratory an afterthought for managed care organizations?","volume":"42","author":"Forsman","year":"1996","journal-title":"Clin Chem"},{"key":"2020081220045939700_i1543-2165-142-3-358-b02","article-title":"National health expenditure projections 2014-2024","author":"Centers for Medicare and Medicaid Services","year":"2016"},{"issue":"11","key":"2020081220045939700_i1543-2165-142-3-358-b03","doi-asserted-by":"crossref","first-page":"e78962","DOI":"10.1371\/journal.pone.0078962","article-title":"The landscape of inappropriate laboratory testing: a 15-year meta-analysis","volume":"8","author":"Zhi","year":"2013","journal-title":"PLoS One"},{"key":"2020081220045939700_i1543-2165-142-3-358-b04","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/criticalvalues\/5.2.6","article-title":"Reducing healthcare costs through appropriate test utilization","volume":"4","author":"Alexander","year":"2012","journal-title":"Critical Values"},{"issue":"974","key":"2020081220045939700_i1543-2165-142-3-358-b05","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1136\/pgmj.2006.049551","article-title":"Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy","volume":"82","author":"Miyakis","year":"2006","journal-title":"Postgrad Med J"},{"issue":"4","key":"2020081220045939700_i1543-2165-142-3-358-b06","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/j.1537-2995.2009.02518.x","article-title":"Activity-based costs of blood transfusions in surgical patients at four hospitals","volume":"50","author":"Shander","year":"2010","journal-title":"Transfusion"},{"issue":"7","key":"2020081220045939700_i1543-2165-142-3-358-b07","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1002\/ajh.20888","article-title":"The addition of decision support into computerized physician order entry reduces red blood cell transfusion resource utilization in the intensive care unit","volume":"82","author":"Fern\u00e1ndez P\u00e9rez","year":"2007","journal-title":"Am J Hematol"},{"issue":"6","key":"2020081220045939700_i1543-2165-142-3-358-b08","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1309\/AJCP4W5CCFOZUJFU","article-title":"The next chapter in patient blood management: real-time clinical decision support","volume":"142","author":"Goodnough","year":"2014","journal-title":"Am J Clin Pathol"},{"issue":"2 suppl","key":"2020081220045939700_i1543-2165-142-3-358-b09","first-page":"155S","article-title":"Use of a computer-assisted system for blood utilization review [discussion in","volume":"47","author":"Dzik","year":"2007","journal-title":"Transfusion"},{"key":"2020081220045939700_i1543-2165-142-3-358-b10","unstructured":"Ooley P. ed. 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