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.