New guidance: minimum spacing between common lab tests

Nearly one-quarter of blood tests in Canada would qualify as overuse, according to a 2022 systematic review. That can lead to unnecessary costs, follow-up testing and treatments. Choosing Wisely Canada has tackled the issue with Using Labs Wisely, a new initiative that has recruited more than 150 hospitals to reduce their unnecessary lab tests. Now, along with Canada’s Drug Agency (previously CADTH), they’ve released guidance on how far apart five common lab tests should be spaced. An advisory panel created the minimum retesting intervals—the minimum time that should elapse before a test is re-done—for five common lab tests. They covered tests for antinuclear antibody, hemoglobin A1C, lipase, serum protein electrophoresis and thyroid-stimulating hormone. Hospitals in the Using Labs Wisely program will be especially motivated to use this guidance, but the group says it’s also applicable to any community or hospital labs. Read: How should I respond when a patient asks me to order lab tests their naturopath wants?The guidance includes recommended minimum times between tests and suggested exceptions. It also offers hard stop timings that labs could use to send test orders back to clinicians automatically. For example, in Antinuclear Antibody testing, the guidance says that if an ANA test is positive, clinicians should not order another to monitor patients with suspected or confirmed systemic autoimmune disease. For a hard stop, it suggests a five-year minimum interval. Another states that people with diabetes who haven’t achieved stable glycemic targets should have testing for hemoglobin A1C spaced out by at least three months, and those who have stable glycemic control should have those spaced out by at least six months. But it also includes exceptions, including children and youth who have type 1 diabetes, people who have diabetes and are planning on getting pregnant and those whose blood glucose levels are rapidly changing thanks to medication or lifestyle changes. This is important because lab tests are so common—Canada spends $5 billion a year on them. It also points out that clinicians should use their judgement, and that there might be cases where this guidance doesn’t apply. Read: Choosing Wisely for patients—and the planet

New guidance: minimum spacing between common lab tests

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