We have a new hematologist with a set panel she orders on all her new patients (with initial diagnosis varying from thrombosis .... hypogamaglobinemia ....low WBC/high plt ..... high WBC/low plt).

Every patient has CBC,retic,DAT,TSH,free T4, chemistry panel and serogy (HIV, all hepatitis').

Needless to say my department has been effected by a doubling of DAT requests all from this doctor. Does anyone know of a paper or journal to help me discourage this kind of shot gun testing? Most have good hemoglobins and only one of 28 last month were positive!

Any words of wisdom would be appreciated

I'd collect data and raise the concern with your medical director. If your medical director agrees with what you're presenting the next step would be to set up a discussion with the hematologist.

My experience has been that a DAT is a normal part of a hematology workup.  Our Hematologist order a DAT as part of their anemia and auto immune disorders for new consults.

While it may seem excessive I can understand why a Hematologist would order DATs.  They are not that labor intensive.  If you perceive it as a problem then, as intimated above, keep your stats and let your Medical Director decide to speak with (or not) with the new Doc.

We also see a lot of DATs for anemia workups - seems to be standard with Hem/Onc for rule outs.

Edited October 10, 201311 yr by AMcCord

We get the same here too. A DAT for every hematologist consult workup. Think of it as job security.

DAT for anemia is understable but unless every patient is coming in with that diagnosis, I think you may be onto something. I would track the DATs she orders and let the data do the talking. Present it to the medical director with your concern and he/she can talk to the hematologist to find out what the reasoning is. Many hospitals are looking at utilization including lab tests.

I agree that doing a DAT on every patient is almost certainly wrong but never underestimate the power of a DAT - for Haematologists move in mysterious ways !

I used to tend the needs of 4 Consultant Haematologists who all used completely different (and secret) criteria for selecting which patients required a DAT.

The only thing they had in common was their immense gratitude when, based on other serological findings, we performed a DAT which gave an unexpectedly positive result - they appeared to find this extremely useful in their diagnosis and treatment - even though they never explained exactly how.

It seems a relatively cheap and easy way of keeping an important and fairly benign alien species happy.

I love Terri's perspective of it as job security, hahaha.

Not really sure where I fall on this one.  I'm am 100% against unnecessary testing and I would think that every patient of this dr would have a few that a DAT would be of no benefit at all.  On the other hand a DAT is quick and simple and I am all about job security.  I do have a question.  What is you DAT protocol for these patients?  A simple Polyspecific DAT and that's it or do you go beyond this?  

I remember  at some place have read a saying that healthy person may have pos DAT.

That is true Yanxia.

Many of those tests seem like overkill (not just the DAT) if the physician is indeed ordering them for ALL his or her patients.  But I agree this is an issue for your medical director and or administrative director.

 

(BTW - doing unecessary testing is wasteful -- "job security" in this context should be seen as a cynical joke, not good practice!)

 

Scott

^{You might also check the CMS reimbursement rules and the diagnosis codes for the patients.  That could give you more information about whether or not the testing is considered routine for the patient's condition.}

Hi Janet,

It seems to me that perhaps you are having an issue with having to perform DAT's. Please take into consideration that the hematologist knows what that he/she is doing. I am not trying to be difficult, but I guess that I do not see what the issue is. Hematologists are Hematologists for a reason, and we have to have faith that they know what is going on with their patients, so that we can provide the best and most accurate results for them! Just saying...

~KLS

 

Many of those tests seem like overkill (not just the DAT) if the physician is indeed ordering them for ALL his or her patients.  But I agree this is an issue for your medical director and or administrative director.

 

(BTW - doing unecessary testing is wasteful -- "job security" in this context should be seen as a cynical joke, not good practice!)

 

Scott

Just to clarify...yes, it was certainly a cynical joke. Would be a serious compliance issue if we were just doing tests to drum up some business. The DATs that we get from hematologists seem to be warranted, when they are working up a patient to rule out hemolytic anemia.

 

Just to clarify...yes, it was certainly a cynical joke. Would be a serious compliance issue if we were just doing tests to drum up some business. The DATs that we get from hematologists seem to be warranted, when they are working up a patient to rule out hemolytic anemia.

 

The thing to keep in mind is that we do not order tests and we do not determine what is unnecessary.  You can take your concerns to your medical director or some committee but I have found over the years that unless it is something life threatening most medical directors I've worked with are unwilling to challenge another doctor's ordering practice so viewing such practices as job security is simply a coping mechanism that gets most of us through the day.  There, more philisophical drivel!