To test or to not test: A retrospective cross-sectional study on potentially inappropriate use of pathology testing in South Australian hospitals

Am J Clin Pathol. 2024 Apr 3;161(4):342-348. doi: 10.1093/ajcp/aqad153.


Objectives: To measure rates of potentially inappropriate pathology testing in the hospital setting.

Methods: Retrospective cross-sectional study in hospital setting from July 2021 to December 2021. We examined 3 potentially inappropriate uses: overordering, selection errors, and unnecessary repeat testing. Overordering included vitamin D and lipids (rarely required in acute hospital care). Selection error was the ratio of iron studies to standalone ferritin requests. Unnecessary repeats included any repeat vitamin D, lipids, iron, or ferritin in an episode of care or C-reactive protein (CRP) repeated within 3 days and N-terminal pro-brain natriuretic peptide (NT-proBNP) within 7 days and repeated previously abnormal CRP and NT-proBNP tests. Costs of inappropriate tests were estimated using the Australian Medicare Benefits Schedules.

Results: Among 55,904 test requests, 15% (n = 8120) were potentially inappropriate. Vitamin D was frequently ordered (n = 4498), as were lipids (n = 2872). Ratio of iron studies to standalone ferritin was 36. Of 19,233 repeat CRPs, 36% (n = 6947) were within 3 days and 62% (n = 179) of repeat NT-proBNPs were within 7 days of the first test. For initially abnormal tests, 89% of CRPs and 97% of NT-proBNPs remained abnormal. Inappropriate test costs accounted for 12% to 30% of costs.

Conclusions: Frequent potential inappropriate use and selection of pathology tests was observed in South Australian hospitals.

Keywords: clinical laboratory services; clinical pathology; education; hospital care; informatics; management/administration; medical laboratory science; quality.

MeSH terms

  • Aged
  • Australia
  • Biomarkers
  • C-Reactive Protein / analysis
  • Cross-Sectional Studies
  • Ferritins
  • Hospitals
  • Humans
  • Iron / metabolism
  • Lipids
  • National Health Programs*
  • Natriuretic Peptide, Brain* / metabolism
  • Peptide Fragments
  • Retrospective Studies
  • South Australia
  • Vitamin D


  • Natriuretic Peptide, Brain
  • C-Reactive Protein
  • Ferritins
  • Peptide Fragments
  • Vitamin D
  • Iron
  • Lipids
  • Biomarkers