Frequency, Causes and Economic Impact of Repeat Testing in a Clinical Biochemistry Laboratory of a University Hospital in Nepal
Keywords:
Repeat testing, Critical Values, Turnaround time, Reproducibility of Result, Laboratory CostAbstract
Background: Repeat testing is a common practice in clinical laboratories intended to confirm critical or unexpected values. Unnecessary repeat tests contribute to increased workload, increased turnaround time (TAT), and higher operational costs. However, there is a lack of standardized, evidence-based guidelines to govern repeat testing, particularly in resource-limited settings. This study aimed to analyze the frequency and patterns of repeat biochemical testing in a university hospital laboratory and to assess the associated reporting delay and economic burden.
Methods: A cross-sectional observational study was conducted in the Clinical Biochemistry Laboratory of Dhulikhel Hospital for a duration of one month. Biochemistry analyzer records were reviewed to identify repeated tests. The frequency of repeat per analyte, reasons for repetition, and concordance between initial and repeat results were assessed. The average delay in reporting due to repeat testing and the direct cost incurred were calculated.
Results: Out of 95,757 total tests, 701 (0.73%) were repeated across 43 analytes. Higher repeats occurred in low-volume tests, notably urine albumin (50%) and β-hCG (12.04%). Critical values were the most common reason for repetition (44.37%). For most of the analytes, no clinically significant difference was found between initial and repeat results. Repeat testing caused a mean reporting delay of 64 ± 41 minutes and incurred a total additional direct cost of NPR 153,188.
Conclusion: Although repeat testing plays an important role in confirming critical values and ensuring patient safety, a substantial proportion of repeated biochemical tests showed no meaningful change from the initial results. Reducing avoidable repeat testing through standardized guidelines and strengthened quality management practices may improve laboratory efficiency, reduce turnaround time, and optimize resource utilization without compromising patient care.
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