Inappropriate pathology ordering and pathology stewardship

An effective system of stewardship is needed to optimise the use of pathology tests

Many hospital clinical pathology laboratories presently experience annual increases in workload of 5%–10%.1 Such increases in demand are often not accompanied by concomitant increases in laboratory resources. This environment presents a significant challenge to laboratories that have no control over test-ordering patterns. Compounding this situation is the fact that many pathology tests are inappropriate or unnecessary, as they have no impact on patient care. The extent of inappropriate pathology test ordering in Australia is unknown, but a United Kingdom report on National Health Service pathology services estimated that 25% of all requests were unnecessary or inappropriate.2 Such tests are ordered for a variety of reasons, often in the belief that more testing equates to better patient care. Unfortunately, this is not always the case, and in some circumstances the opposite may be true.