Many tests are ordered more frequently than is necessary for patient care. The cost of drawing the sample and testing it is significant and so is the inconvenience for patients. For babies, even minor blood loss from testing can be significant. The proper frequency of testing is, of course, going to vary depending on many factors (the patient's declining or improving health, how compliant they are, what treatments are/were given, etc.) The UM team should not micromanage clinicians in prescribing specifically approved frequencies for all tests. Instead, the UM team should consider frequencies for some routine screening tests. Some examples for outpatient tests are given below.
Hemoglobin A1c (A1c): Although the A1c test is very important in the management of diabetes, it is often ordered too frequently. A1c testing more frequently than every three months is not clinically useful. Since the half-life of glycated hemoglobin is so long, the difference between two A1c values performed close together won't be clinically or analytically different. It takes a big change in glycated hemoglobin to produce a significant difference in the A1c value.
Vitamin D (vit D): Many clinicians measure vit D routinely as part of a basic wellness visit. Unless clinically-significant deficiencies are really a concern, vit D should not be routinely measured.
Prostate specific antigen (PSA): The PSA test is not very sensitive or specific for prostate cancer. Its use as a screening test is no longer endorsed by the U.S. Preventive Services Task Force (though urologists still consider it useful). The frequency of PSA testing in men is related to their risk and age but it seems clear that the test is ordered too frequently on asymptomatic men.
Serum protein electrophoresis (SPE): Most patients being monitored with routine SPE have a benign monoclonal gammopathy of undetermined significance (MGUS). Clinicians will often order SPEs for these patients every month or every three months. However, an order for a SPE on an asymptomatic patient should only occur once per year.
The tests above are just a few examples of tests that are useful but are often ordered too frequently on the same patient. Redundant or too-frequent testing is also a concern for the inpatient.
