Reducing pathology testing in emergency departments: A scoping review

BACKGROUND: Pathology testing in emergency departments (EDs) is often unnecessary, leading to avoidable financial and environmental costs without improving clinical care. This overview summarises interventions to reduce pathology testing in EDs, their effectiveness, and any resulting financial, environmental, patient, or staff impacts.

METHODS: We searched multiple databases up to February 2025 and conducted citation searches. Eligible studies included intervention and aetiological observational studies of pathology tests in EDs. Secondary studies and conference abstracts were excluded.

RESULTS: Of 1,755 records, 34 studies met inclusion criteria: 32 quality improvement studies, one cohort study, and one randomised controlled trial. Interventions included ordering system changes, education, audit & feedback, guideline development, penalties, and alternative care models. Significant reductions ranging from 1.5% to 99% (median: 29%) in targeted pathology tests were reported in 33 of 34 studies. All 25 studies reporting financial impacts found cost reductions, with potential savings up to AUS$1 million in one Australian ED over 18 months (median:US$247,000 per year for nine studies reporting annual savings in US$). No adverse patient or staff impacts were found. No studies reported on environmental impacts.

CONCLUSION: Nearly all interventions reduced test frequency with beneficial or no impacts on patient care and staff efficiency, along with notable cost savings. Future studies should include environmental impacts and assess clinical care co-benefits of reducing unnecessary pathology testing.