APPROPRIATENESS OF CLINICAL REQUEST: IS IT POSSIBLE TO MEASURE IT?

Background: Evaluation of the requested tests appropriateness (AT) is a domain of the pre-analytical phase where laboratory is strongly involved, but its measurement is very difficult for laboratory professionals because it requires a deep knowledge of the patient’s health care status. The Aim of this work is to report the results of two quality indicators (QIs) to measure the percentage of requests reporting the clinical question (CQ) and the appropriateness of requested tests. Materials and methods: 797 outpatient requests, collected in November 2013, were counted and the AT analyzed (by a group of laboratory professionals on the basis of clinical recommendations about the use of tests) with respect to CQ (776) and data stored in our repository. Results: 2013 requests with CQ (97%) compared to 2007 ones (26,5%) resulted: congruent, 71.1% and 80.4%; partially congruent, 12.2% (17% missed, 83% added tests) and 8.2%; incongruent (not responding to CQ), 11.2% and 3.1%; with unspecific CQ, 5% and 2.3%; with incorrect CQ, 0% and 0.8%; difficult to assess, 0.5% and 5.2%. In many cases, requests with added tests concern patients with diseases (51.6%) that are not linked to reported CQ or patients free of costs (48.4%, i.e. disabled, low-income). Conclusions: The requests with CQ increased over time while the appropriateness slightly decreased. This could be due to the issue of a national regulation that imposes the introduction of CQ in the requests and a raising awareness of laboratory but, also, it highlights the need to better educate physicians on the appropriate use of the test. Even if it has been not assigned the higher priority for the difficulty of measurement to the two QIs introduced in the list proposed in the Consensus Conference held in Padova on 2013, their use is very important to identify the aspects that negatively impact on appropriateness