Five new recommendations published by the American Board of Internal Medicine Foundation’s Choosing Wisely initiative.
The American Society for Clinical Laboratory Science (ASCLS), in collaboration with the American Society for Clinical Pathology (ASCP) and the American Society for Microbiology (ASM), has published a series of recommendations for the Choosing Wisely initiative, operated by the American Board of Internal Medicine (ABIM) Foundation.
Cindy Johnson, MS, MLS (ASCP)CM, ASCLS president, and George Fritsma, MS, MLS(ASCP)CM, Choosing Wisely Committee chair, announced that the following recommendations were posted to the Choosing Wisely site:
- Do not order a factor V Leiden (FVL) mutation assay as the initial test to identify a congenital cause for a thrombotic event. First, order a phenotypic activated protein C resistance (APCR) ratio assay.
- Do not use herpes simplex virus (HSV) polymerase chain reaction (PCR) testing for genital HSV infection screening in adults and adolescents. Real-time HSV PCR testing should only be used to confirm herpes diagnosis in patients with suspected herpes.
- Do not transfuse red blood cells as the sole intervention for expansion of circulatory volume unless deemed necessary for patients experiencing severe hemorrhage.
- Avoid using hemoglobin to evaluate patients for iron deficiency in susceptible populations. Instead use ferritin.
- Do not order a comprehensive stool ova and parasite (O&P) microscopic exam on patients presenting with diarrhea less than seven days’ duration who have no immunodeficiency or no history of living in or traveling to endemic areas where gastrointestinal parasitic infections are prevalent. If symptoms of infectious diarrhea persist for seven days or longer, start with molecular or antigen testing and next consider a full O&P microscopic exam if other testing is negative.
These recommendations, amplified with clarifying discussions and references, appear on the Choosing Wisely web site.
Founded as a task force in 2017, the ASCLS Choosing Wisely Committee develops Choosing Wisely recommendations in consultation with the ASCLS Scientific Assemblies and Board of Directors.
“Our many medical laboratory science educators incorporate Choosing Wisely recommendations in course modules prepared for undergraduate and graduate medical laboratory science students, physician assistant and nurse practitioner programs, entry-level nursing programs, and pathology residents,” said Mr. Fritsma. “The committee’s activities are ongoing, and we invite recommendation suggestions from throughout the in vitro diagnostics industry.”
The American Society for Clinical Laboratory Science (ASCLS) and its 9,000 clinical laboratory professional, student, and educator members in more than 50 state and regional constituent societies work to advance the expertise of clinical laboratory professionals who, as integral members of interprofessional healthcare teams, deliver quality, consumer-focused, outcomes-oriented clinical laboratory services through all phases of the testing process to prevent, diagnose, monitor, and treat disease. The Society promotes high standards of practice by holding the profession accountable to a Code of Ethics, through dissemination of knowledge at educational programs, and through publications; maintains a supportive community to advocate on behalf of current and future laboratory professionals; and provides laboratory professionals a voice to legislators and regulators through collective, grassroots efforts.
Choosing Wisely promotes conversations between clinicians and patients by helping patients choose care that is supported by evidence, does not duplicate tests or procedures, is free from harm, and is truly necessary. Beginning in 2012, national organizations representing medical specialists have asked their members to identify tests or procedures commonly used in their field whose necessity should be questioned and discussed. This call to action has resulted in specialty-specific lists of “Things Providers and Patients Should Question.”