A significant increase in serum folate test orders has been identified at a leading Brazilian academic hospital, highlighting potential inefficiencies in current medical practices.
Rising Test Volumes and Low Abnormality Rates
Between January 2018 and December 2022, the hospital recorded 181,379 folate tests administered to 82,052 patients. Despite the high number of tests, only 0.7% returned abnormal low results. The majority of these tests were conducted in outpatient settings, accounting for 89.5% of all orders. The Gastroenterology and Nephrology departments were the primary sources, responsible for 33% and 9.8% of the tests respectively.
Frequent Re-testing Suggests Redundancy
A substantial portion of patients, 74.8%, underwent multiple folate tests. Specifically, 135,787 re-tests were performed on 36,300 individuals, with most repetitions occurring within three to six months of the initial test. Only a small fraction, 24,243 repetitions, took place after more than a year, indicating a pattern of frequent and possibly unnecessary testing.
• The low rate of abnormal results questions the clinical necessity of frequent folate testing.
• Predominant ordering by Gastroenterology and Nephrology may reflect department-specific protocols rather than patient need.
• High re-test frequencies suggest a lack of streamlined guidelines for folate monitoring.
The data points to a trend of increasing folate test orders that may not align with clinical guidelines or patient requirements. The rise from 33,988 tests in 2018 to 44,187 in 2022 underscores the need for a review of testing protocols to ensure resources are utilized effectively.
Optimizing folate test ordering could reduce unnecessary healthcare costs and prevent patient fatigue from redundant testing. Implementing stricter guidelines and promoting targeted testing based on specific clinical indications may enhance the efficiency of laboratory services.
Ensuring that folate tests are ordered based on clear clinical criteria can lead to better patient outcomes and more sustainable healthcare practices. Hospitals should consider auditing their test ordering patterns and providing training to healthcare providers to foster evidence-based testing strategies.
By addressing the surge in folate testing, the hospital can better allocate resources, reduce unnecessary procedures, and focus on delivering high-value care to patients. This approach not only benefits the institution but also enhances overall patient care quality.
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