In the October issue of Clinical Laboratory News (CLN), Joshua Hayden, PhD, DABCC, FACB, describes the five critical steps his laboratory at Weill Cornell Medicine in New York City took to reduce emergency department (ED)-based serum amylase orders, 80% of which they estimated were unnecessary.

The first is to select the right test to assess, wrote Hayden, assistant director of the central laboratory. His lab chose serum amylase orders because “we believed this was a safe initial choice with little anticipated pushback at efforts to limit the test’s use—an ideal characteristic for our first foray into curbing test utilization.” They also considered the financial impact of curtailing utilization.

Hayden’s team then assembled published literature on the test’s utility and consulted with peer organizations. Armed with that data, they found clinical colleagues to support their efforts. When approaching potential allies, he advises beginning with innocuous questions rather than demanding statements. For instance, ask, “Why do you normally order amylase?” instead of “Stop ordering amylase.” And don’t forget to talk to residents, he counsels, since they typically order most tests in academic medical centers.

The next step is to identify the root cause of the overutilization. At Weill Cornell, he writes, the major reason for overutilization was the fact that amylase was included in the abdominal pain order sets.

The solution? Remove amylase from the ED abdominal pain order set.

Since then, he writes, the hospital has gone from about 10 ED-based serum amylase orders a day to fewer than two, a projected reduction of about 3,000 tests. “More importantly,” he concludes, “successfully tackling amylase over-ordering created a culture of lab utilization management and laid a path for addressing overutilization which we are using with other analytes.”

For more details, pick up the October issue of CLN.