COVID-19 Pandemi Sürecinde Klinik Biyokimya Laboratuvarında Akılcı Laboratuvar Kullanımı: Test İstemlerinin Retrospektif Değerlendirmesi

Amaç: COVID-19 şüpheli poliklinik hastalarından istenen biyokimyasal testlerin yönergelere uygunluğunu değerlendirmeyi amaçladık. Gereç ve Yöntemler: 1 Mart - 1 Haziran 2020 tarihleri arasında COVID-19 ön tanılı hastaların demografik ve biyokimyasal verileri retrospektif olarak incelendi. Bulgular: Biyokimya laboratuvarında incelenen toplam hasta sayısı 1618, toplam test sayısı 26260 idi. Hastaların toplam test sayısının % 30’unun kılavuza uygun olmadığı bulundu. Sonuç: Refleks ve reflektif test uygulamaları ile laboratuvar uzmanlarının hastaların klinik karar sürecine ve hastanelerin mali bütçesine katkıda bulunmaları sağlanmalıdır.

Appropriate Laboratory Using In Clinic Biochemistry Laboratory During The COVID-19 Pandemia: Retrospective Evaluation of Test Orders

Aim: We aimed to evaluate the compliance of the biochemical tests requested from COVID-19 suspected polyclinic patients to the guidelines. Material and Methods: Demographic and biochemical data of patients with a pre-diagnosis of COVID-19 between March 1 and June 1, 2020 were examined retrospectively. Results: The total number of patients examined in the biochemistry laboratory was 1618, the total number of testswas 26260. It was found that 30% of the total number of tests did not comply with the guide. Conclusion: It should be ensured that laboratory specialists by reflex and reflective test applications within appropriate laboratory contribute to the clinical decision process of patients and the financial budget of the hospitals.

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1. Freedman DB. Towards better test utilization - strategies to improve physician ordering and their impact on patient out- comes. EJIFCC 2015;26(1):15-30.  
2. Zhi M, Ding EL, Theisen-Toupal J, Whelan J, Arnaout R. The landscape of inappropriate laboratory testing: A 15-year meta- analysis. PLoS One 2013;8(11):e78962.
3. T.C. Sağlık Bakanlığı Tetkik ve Teşhis Hizmetleri Dairesi Başkanlığı: Akılcı laboratuvar kullanım projesi. Erişim 07.06.2020, https://tetkikteshis.saglik.gov.tr/TR-32919/akilci-laboratuvar-kullanimi-projesi.html.
4. Henry BH, Santos de Oliveira MH, Benoit S, Plebania M, Lippia G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirusdisease 2019 (COVID-19): A meta-analysis. Clin Chem Lab Med 2020;25;58(7):1021-1028.
5. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü: COVID-19 (SARS-CoV-2 enfeksiyonu bilim kurulu çalışması) rehberi. Erişim 08.06.2020, https://covid19bilgi. saglik.gov.tr/tr/covid-19-rehberi.html.
6. T.C. Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliği (SUT). Erişim 08.06.2020, http://www.sgk.gov.tr/wps/ portal/sgk/tr/kurumsal/merkezteskilati/ana_hizmet_birimleri/gss_genel_mudurlugu/anasayfa_duyurular/guncel_ sut_28122018.
7. Casalino LP, Dunham D, Chin MH, Bielang R, Kistner EO, et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med 2009;169:1123-1129.
8. Badrick T. Evidence-based laboratory medicine. Clin Biochem Rev 2013;34(2):43-46.
9. Plebani M, Sciacovellia L, Marinova M, Marcuccitti J, Chiozza ML. Quality indicators in laboratory medicine: A fundamental tool for quality and patient safety. Clin Biochem 2013;46(13-14):1170-1174.
10. Nicoll D, Pignone M. Basic principles of diagnostic test use and interpretation. In: Nicoll D, McPhee JS, Pignone M, Detmer WM, Chou TM, editors. Pocket guide to diagnostic tests 3th ed. Lange Medical Books/McGraw-Hill; 2001.5-6.
11. Cadamuro J, Ibarz M, Cornes M, Nybo M, HaschkeBecher E, vonMeyer A, Lippi G, Simundic AM. Managing inappropriate utilization of laboratory resources. Diagnosis (Berl) 2019;6(1):5-13.
12. Laposata M. Putting the patient first - using the expertise of laboratory professionals to produce rapid and accurate diagnoses. LabMed 2014;45:4-5.
13. vanWalraven C, Naylor CD. Do we know what inappropriate laboratory utilization is? A systematic review of laboratory clinical audits. JAMA 1998;280(6):550-558.
14. Cadamuro J, Gaksch M, Wiedemann H, Lippi G, vonMeyer A, Pertersmann A, et al. Are laboratory tests always needed? Frequency and causes of laboratory over use in a hospital setting. Clin Biochem 2018;54:85-91.
15. Güven B, Can M. COVID-19 pandemi sürecinde biyokimya laboratuvarı akış ve güvenlik prosedürleri: Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Deneyimi. Med J West Black Sea 2020;4(2):39-43.
16. Srivastava R, Bartlett WA, Kennedy IM, Hiney A, Fletcher C, Murphy MJ. Reflex and reflective testing: Efficiency and effectiveness of adding on laboratory tests. Ann Clin Biochem 2010;47:223-227.
17. Verboeket-van de Venne WP, Aakre KM, Watine J, et al. Reflective testing: Adding value to laboratory testing. Clin Chem Lab Med 2012;50:1249-1252.