Appropriate laboratory utilization in diagnosing pulmonary embolism

Ann Clin Biochem 2009;46:18-23
© 2009 Association for Clinical Biochemistry


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Original Articles

Fiappo Eva1,
Quattrin Rosanna2,
Calligaris Laura2,
Cappelletti Piero1 and
Brusaferro Silvio2

1 Azienda Ospedaliera ‘Santa Maria degli Angeli’, Pordenone;
2 Azienda Ospedaliero-Universitaria ‘Santa Maria della Misericordia’, Udine, Italy

Corresponding author: Quattrin Rosanna, Azienda Ospedaliero-Universitaria, ‘Santa Maria della Misericordia’, Via Colugna, 50, 33100 Udine Italy. Email: quattrin.rosanna{at}

Background: The appropriateness of clinical laboratory use in hospital clinicalpractice is a very debated question. In fact diagnostic testsare essential tools for disease screening or diagnosis but atthe same time they represent an important expenditure.

Methods: A quantitative study was conducted in an Italian general hospitalwith 535 beds and about 27,000 admissions per year. The samplewas made of all patients discharged from the hospital with DRG78 between the period 1 January 2005 and 31 December 2005.

Results: The Emergency Department (ED) discharged 2.9% (116/4009) of patients with pulmonary embolism diagnosis in the year 2005. The percentage of prescription inappropriateness inferred by analysis of all required tests by operative unit was 21.7% (950/4385). The approximate estimate of the economic value of unnecessarily required tests was of 3495{euro}. Of these 96.5% (112/116) had enlistingcriteria. All haematological and clinical-chemical tests (1295)concerning studied patients were analysed. About 70.4% (93/132)of d-dimer tests were ordered in ED. In the studied patients,unfractionated heparin was administered in 17.8% (20/112) ofthe cases, low-molecular weight heparin in 79.5% (89/112) andheparin therapy was not administered in 2.7% (three of 112).

Conclusion: This study uses a method to assess the quality of laboratorytest orders using results as a tool to estimate the impact ofeconomic resources devolved in executing inappropriate tests.

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