Why Lab Test Ordering Misses the Mark: Key Factors

How often do unnecessary tests occur in an average laboratory? Take whatever number comes to mind and multiply it by five – that’s likely closer to reality.

Unnecessary and incorrect tests are major challenges for laboratories. Various factors contribute to this issue. Below, we will explore common factors that cause lab testing practices to fall short, along with real-world examples and insights into how technology can help address these challenges.

 

Gaps in Medical Education

Anyone working in a lab knows that testing patterns can sometimes be unusual. While professionals spend considerable time ordering tests, they receive surprisingly little formal training on how to order and interpret them. For example:

• Only 9% of medical schools offer dedicated courses in laboratory diagnostics.

• On average, medical schools provide just 10 hours of instruction on lab testing.

• In some cases, this is reduced to less than 5 hours.

This leaves many professionals learning on the job, often from outdated practices, which isn’t a recipe for success.

 

Paperwork Overload

When we implemented WizardLab (our laboratory information system) at a large university hospital, we quickly saw how paper-based systems contribute to errors. On the very first day, the lab manager called us, concerned that one patient had undergone the same test four times in a single day.

Initially, we thought it was a system error, but it turned out the patient had been to multiple specialists and had given blood samples at each visit, thinking it was standard procedure.

This case, while extreme, highlights a broader issue: Paper-based labs are prone to errors. When samples aren’t barcoded, mix-ups are more common, leading to incorrect results being assigned to the wrong patients. Delays in results, coupled with doctors’ inability to access them electronically, also lead to unnecessary repeat testing.

 

Defensive Test Ordering

Fear can often drive test ordering practices. Joseph E. Hardison from Emory University School of Medicine wrote about this as early as 1979 discussingthe excuses professionals use when ordering tests. Although it’s been over 35 years, these reasons remain relevant today:

• “I’ll get in trouble if I don’t order” – This excuse arises when less experienced practitioners worry about how their supervisors will react if they don’t order every possible test.

• “Ready to fish” – When someone isn’t sure what’s wrong with the patient, they may order a wide array of tests in the hope that something useful will show up.

• “Lawsuit defense” – Here, tests are ordered to protect against potential legal action, rather than to benefit the patient.

These examples show that test ordering is sometimes driven by fear rather than by clinical indications or protocols.

 

Issues with Test Grouping

Improper grouping of tests is another major cause of overtesting. Doing 10 tests when only one is needed, or ordering extensive panels, is often justified with the mantra, “the more, the better.” For instance:

• Allergy Testing: Although most allergies can be detected with a small panel of allergens, we often see tests ordered with over 20, or even 400, allergens.

Such broad testing increases the likelihood of false positives, making it harder to distinguish between actual health issues and noise.

 

Who Orders Tests?

In many places, lab test ordering isn’t limited to medical professionals. Depending on the laws, patients, nurses, and even pharmacists can order tests.

While patients might have access to plenty of information online, their choices are often swayed by ads or social media, rather than medical guidelines.

Even when patients can’t order tests themselves, they may pressure their healthcare providers to do so. It sometimes feels like everyone except the lab staff has a say in test ordering.

 

The ‘Who Cares’ Labs

Errors in test ordering and interpretation are among the top mistakes affecting patient outcomes. Why? Because many laboratories avoid interfering with clinicians’ ordering habits and fail to recognize the importance of collaboration.

Some labs understand this need and work to integrate their expertise into the ordering process. However, others adopt a more indifferent approach, focusing on quantity over quality. Private labs, driven by market demands, and hospital labs sticking to outdated methods often fall into this category.

 

Wrap-up

It’s a misconception that errors in lab testing are solely due to those placing the orders.

In reality, everyone in the care chain, from patients to lab staff, plays a role in ensuring accurate and efficient test ordering. By understanding these six factors, and with the support of good will and technology labs and clinical teams can work together to improve practices.

In upcoming posts, we’ll explore how lab leaders can use technology to enhance collaboration with clinical departments and drive better outcomes.