An analysis of the overuse and underuse of laboratory testing by skilled medical professionals when assessing patients for thrombotic and bleeding problems

Abstract

Background: Diagnostic errors, particularly in test selection, are a significant contributor to misdiagnoses and delayed treatments. Both overutilization and underutilization of laboratory tests have been recognized as prevalent issues, yet little is known about their frequency and clinical impact, especially in the context of coagulation disorders. This study investigates overutilization and underutilization of coagulation tests by expert physicians in the evaluation of patients with bleeding and thrombotic disorders.
Methods: This study included 300 selected patient cases was at a healthcare institution. The cases were discussed in daily meetings by a coagulation diagnostic management team, consisting of pathology residents and attending physicians. Data from electronic health records, including test results and diagnoses, were analyzed for errors in test selection. The frequency of overutilization and underutilization was assessed, and the financial burden of unnecessary tests was estimated. Statistical analyses included the Fisher exact test and t-tests to evaluate associations between patient characteristics and test selection errors.
Results: The analysis revealed that 77.5% of cases involved errors in test selection, with 44% of patients experiencing underutilization, 16% overutilization, and 17.5% both over and underutilization. Errors were more prevalent in African descent and Hispanic patients, women, and younger patients. The total unnecessary cost of overutilized tests across the 300 cases was SAR6054, with an estimated annual burden of SAR18,162.
Conclusion: Nearly 75% of cases involved diagnostic errors in test selection, emphasizing the prevalence of overutilization and underutilization in coagulation testing. The study highlights the need for increased awareness and real-time expert reviews to optimize test utilization and reduce diagnostic errors, ultimately improving patient outcomes and reducing unnecessary healthcare costs.