66 Evaluating the Impact of an Expanded Trainee-Led Miscellaneous Test Request Review Process on Laboratory Stewardship
Bibliographic record
Abstract
Abstract Clinicians at our institution can request esoteric tests not included in the standard test menu through a miscellaneous order process. While this flexibility allows access to specialized testing, it also introduces possibilities of errors. To address these challenges, a trainee-led review process of miscellaneous requests for chemistry tests was established to systematically assess these requests. Since beginning the process, we have slowly expanded the review to include other disciplines of testing. With now over thirty months of data, we evaluated the effectiveness of the program and how it is changed since initialization. We conducted a retrospective analysis of miscellaneous test request reviews over thirty months. The review process was conducted using our laboratory information system (Epic Beaker) to flag tests for review after specimen collection. Pathology residents reviewed the flagged tests daily and logged them into a shared, secure Excel-based tracker. Residents consulted with medical directors from the relevant laboratory sections for guidance as needed, and a medical director conducted a final daily review to complete the process. Additionally, residents met with a medical director weekly to discuss test requests and evaluate the review workflow. Since establishment of the review process, 4,766 tests requests have been reviewed, increasing from 312 in the first quarter of the program to 569 in the most recent completed quarter due to gradual expansion of the review into non-chemistry disciplines. Requests originate from internal (61.3%) and external/client providers (38.7%). As expected, chemistry tests account for 89.4% of requests; the two next largest categories are microbiology (6.4%) and immunology (3.6%). Of all reviewed requests, 80.6% were approved without modification, while 5.2% were canceled due to redundancy or inappropriateness. An additional 11.7% were converted to a defined in-house test, 1.7% were redirected to an alternative reference laboratory, and 0.8% required modifications to the test ordered. Interventions in all categories except approvals increased over time, reflecting improved recognition of inappropriate or misrouted tests. The median time spent per review was 1 minute, with complex interventions, such as order modifications and redirections, requiring additional time (∼30 minutes). Expanding the scope of the review provided further insights into provider ordering patterns and opportunities for test stewardship initiatives. This review highlights the continued effectiveness of a trainee-led miscellaneous test request review process in optimizing test selection and utilization. The findings support ongoing efforts to engage trainees in laboratory stewardship initiatives to enhance efficiency, reduce inappropriate testing, and improve patient care. Additionally, this process has served as an educational tool, improving residents’ knowledge of esoteric testing and its appropriate use. To further strengthen this initiative, we plan to continue to expand this review process to other laboratory discipline, allowing residents to develop specialized expertise and contribute more effectively to test stewardship.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.079 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".