Defining Stats

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The page below is a sample from the LabCE course Laboratory Effectiveness: Clinical Laboratory Utilization. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Defining Stats

Stat tests are tests that need to be performed as soon as possible. The test results provide critical information that will affect the patient's treatment. Stat testing might not come to mind immediately as an issue for a UM team. However clinics and health care systems that have limited testing menus may be forced to send testing outside the health care system at increased costs, if a patient presents with high-acuity symptoms and the clinician decides to order a battery of tests stat.
Let's consider an example. A patient presents to the provider at the clinic with shortness of breath, fatigue, and confusion. The clinic has some basic point-of-care testing (POCT) available but the clinician wants a troponin, BNP, and tests for anemia (iron and ferritin) performed stat. The health care system's main testing laboratory is located an hour away. The physician decides to have the lab tests collected and sent via taxi to a nearby hospital laboratory, which is not part of this clinic's health care system. The cost per test at this facility averages $25 and the cab fare must be added in as an additional cost.
The troponin, and maybe even the BNP, are legitimate stat tests, given the patient's symptoms. But what about the iron and ferritin tests? The clinic's own testing laboratory can no doubt perform the iron and ferritin tests for much cheaper. Are iron and ferritin truly stat tests? That is, will those test results provide critical information that will affect the patient's treatment at this time? Or, can those tests be performed at a later time, after this current acute crisis is over? We need to ask, "how time-critical is each lab test?"
Another common scenario is that some laboratories schedule staffing around batched tests. For example; a lab may run tacrolimus testing at 9 am and 1 pm every day. After 1 pm that lab bench is no longer staffed. A stat order for tacrolimus may require that the lab call a technologist in from home to do the test. Or, it may require that a technologist put in overtime to run the stat test. Both of these situations will add significant expense to the testing.
Many clinicians think that any test, given the right context, can be a stat test. However, given the nature of some tests this belief is unjustified.
Your UM team may want to list which tests can legitimately be ordered as stats. An example of one institution's list of approved stats is given in the table on the right. The list of approved stat tests will vary based on patient population or physician practices.