Inappropriate pathology ordering and pathology stewardship

To the Editor: We commend Spelman's insightful discussion of the need for pathology stewardship.1

The Royal College of Pathologists of Australasia (RCPA) advocates a structured approach underpinned by national standards, aimed at minimising harm to patients as well as reducing laboratory and hospital costs. The College recommends hospital pathology stewardship programs with multidisciplinary input; harmonisation of testing and reporting; electronic decision support systems; educational strategies; and collection and analysis of national and state data.

Within this advocacy framework, the RCPA has led or collaborated on many projects relating to harmonisation, standardisation and structuring of reports, consumer benefits and risks, effective communication of results, point-of-care testing, quality of genetic testing (http://www.health.gov.au/internet/main/publishing.nsf/Content/pathology-qupp-index), and a free online educational tool for doctors (http://investigate.med.unsw.edu.au/home.jsf). The College advocates and advises on pathology rotations for junior doctors.

The RCPA Manual (http://www.rcpa.edu.au/Library/Practising-Pathology/RCPA-Manual/Home) provides decision support tools and comprehensive guidance on use and interpretation of pathology investigations.

While these initiatives will promote quality use of pathology, we stress that coordinated support from major national institutions is needed to effect real change.