ASCP announces new Choosing Wisely recommendations

ASCP has released a new set of Choosing Wisely recommendations targeting laboratory tests that are commonly ordered but not always appropriate. ASCP has been a partner in the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation, since 2013 when the Society released its first set of Choosing Wisely recommendations.

The mission of Choosing Wisely is to do the right thing for patients and avoid care that is unnecessary and possibly harmful. ASCP is a major proponent of patient-centered care and evidence-based medicine. The Choosing Wisely campaign aims to help physicians and patients engage in conversations about the overuse of medical tests and procedures and support physician efforts to help patients make smart and effective care choices. Pathologists and laboratory professionals are uniquely positioned to play a key role in promoting and managing the delivery and use of healthcare resources—and creating awareness about appropriate care with clinicians and patients.

For numerous reasons, laboratory tests are often ordered inappropriately. The laboratory tests targeted in ASCP’s new Choosing Wisely recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher-quality care; and eliminating it or changing to another test is within the control of the clinician.

ASCP’s new Choosing Wisely recommendations include:

• Don’t order an erythrocyte sedimentation rate (ESR) to look for inflammation in patients with undiagnosed conditions. Order a C-reactive protein (CRP) to detect acute phase inflammation.
• Don’t test vitamin K levels unless the patient has an abnormal international normalized ratio (INR) and does not respond to vitamin K therapy.
• Don’t prescribe testosterone therapy unless there is laboratory evidence of testosterone deficiency.
• Don’t test for myoglobin or CK-MB in the diagnosis of acute myocardial infarction (AMI). Instead, use troponin I or T.
• Don’t order multiple tests in the initial evaluation of a patient with suspected non-neoplastic thyroid disease. Order thyroid-stimulating hormone (TSH) and, if abnormal, follow-up with additional evaluation or treatment depending on the findings.

The new recommendations were developed by ASCP’s Choosing Wisely Ad Hoc Committee, under the leadership of its Chair and Past ASCP President Lee Hilborne, MD, MPH, FASCP, DLM(ASCP)^CM. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance. The recommendations, based on an extensive review of pathology practice and literature, were developed to result in higher-quality care, lower costs, and more effective use of laboratory resources and personnel.