ASCLS Releases its First Choosing Wisely Recommendations in Collaboration with ASCP and ASM

The American Society for Clinical Laboratory Science (ASCLS), in collaboration with ASCP and the American Society for Microbiology (ASM), has published a series of recommendations for the Choosing Wisely initiative, operated by the ABIM Foundation.

The ASCP Effective Test Utilization Committee welcomed ASCLS and George Fritsma, MS, MLS(ASCP), ASCLS Choosing Wisely Committee chair, to be part of its team this year. As the ASCLS representative, Mr. Fritsma will provide subject matter expertise to guide the development of ASCP’s future priorities and recommendations, advocate for the Choosing Wisely initiative, sharing locally and regionally why it is a unique opportunity for pathology and laboratory medicine leaders to positively impact clinical outcomes and cost reduction.

The following recommendations are included in the ASCLS list:

• 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.

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