Pathology requesting in a regional Australian Emergency Department; an observational study comparing current practice with college guidelines

Introduction: In 2018, the Australasian College for Emergency Medicine (ACEM) and the Royal College of Pathologists of Australasia (RCPA) produced a guideline to encourage appropriate pathology requesting in the Emergency Department (ED).

Objective: To assess adherence to the ACEM/RCPA pathology testing guideline in a regional ED.

Methods, design, setting and participants: This was a retrospective observational study conducted at a regional Australian ED over 7 days. Adults with a presenting complaint encompassed by the guideline were included. All blood tests were audited against the guideline recommendations and classified as indicated or non-indicated. Chi-squared analyses were performed to explore the association between presenting complaint and non-indicated testing.

Main outcome measure: The primary outcome was the number of non-indicated blood tests.

Results: Forty percent of tests ordered were not clinically indicated, with non-indicated testing occurring during 87% of encounters. The C-reactive protein (CRP) was the test most frequently ordered outside of guidelines (94% non-indicated). Patients presenting with lower abdominal pain accounted for nearly one-quarter of all non-indicated tests.

Conclusions: Blood tests were commonly requested outside of the guideline recommendations and interventions to improve pathology stewardship are required.