Time to harmonise common laboratory test profiles

Laboratories can help to limit costs and improve the quality of healthcare in many ways. Some, such as avoiding unnecessary testing and the further investigations and referrals that ensue, are difficult to achieve and measure. Others are more straightforward. One such candidate is the composition of routine laboratory profiles commonly known as urea and electrolytes (U&E), liver function tests (LFT), calcium/bone profiles (bone), and thyroid function tests (TFT). The tests included in these profiles vary between laboratories, often for historical reasons.1 This variation has fallen over the past 15 years, at least among UK subscribers to the comparative national pathology benchmarking initiative,2 but large differences remain. For example, there are 11 different profiles for liver function tests listed by the 49 laboratories subscribing to the initiative.

The ideal profile may not exist, but such differences can cause confusion and potentially affect patient safety. Removing tests that offer little incremental information would save money, avoid further investigation of clinically unimportant minor abnormalities, and remove confusion for doctors moving between hospitals using different laboratories.3 It could also be an initial step towards problem based rather than panel based testing, which might be the ideal solution. We present proposals for rationalisation drawn up by a panel of members of the Association for Clinical Biochemistry. After consultation with members of the association’s clinical practice section, the proposals were debated at its 2011 national scientific meeting, attended by about 100 people.