What is Routine Testing?
Routine testing refers to laboratory tests, imaging studies, or diagnostic procedures ordered automatically in the absence of a specific clinical indication or purpose—essentially "shotgun" or universal testing done without consideration of individual patient risk factors, symptoms, or clinical findings. 1
Core Definition
- Routine tests are ordered without a specific clinical indication, often as part of predetermined protocols or "panels" (e.g., "preop status," "surgical screening," "admission labs") 1
- Indicated tests, in contrast, are ordered for a specific clinical purpose based on patient history, physical examination findings, or known risk factors 1
- Global designations like "preoperative workup" or "medical clearance panel" do not constitute specific clinical indications 1
Clinical Context and Examples
Preoperative Setting
- Routine preoperative testing includes ordering ECGs, chest x-rays, or laboratory panels on all surgical patients regardless of their medical history or the invasiveness of the planned procedure 1
- An indicated preoperative test would be ordering coagulation studies specifically to assess warfarin therapy effects in a patient on anticoagulation 1
Psychiatric Emergency Department Evaluation
- Routine testing in psychiatric patients means ordering extensive laboratory panels, urine drug screens, or imaging on all patients presenting with psychiatric complaints 1
- Indicated testing would be ordering specific tests based on abnormal vital signs, altered mental status, or specific historical/physical examination findings 1
Other Clinical Scenarios
- Routine admission laboratory testing means ordering standard panels (CBC, chemistry, urinalysis, ECG, chest x-ray) on all hospitalized patients simply because they are being admitted 2
- Routine urine analysis in outpatient clinics means performing dipstick testing on all patients regardless of symptoms or clinical indication 3
Why This Distinction Matters
Evidence Against Routine Testing
The overwhelming evidence demonstrates that routine testing has extremely low clinical yield and should be avoided across multiple clinical settings:
- In preoperative evaluation, routine tests show abnormal findings but rarely change clinical management (only 0-9.1% of abnormal routine ECGs led to management changes) 1
- In psychiatric emergency patients with normal vital signs and non-contributory examinations, routine laboratory testing has very low yield and is not recommended 1
- In general medical admissions, only 0.5% of routine admission tests led to changes in patient treatment 2
- In ambulatory medical patients, routine testing had lower therapeutic yield (0-2.2%) compared to history and physical examination (5-7%) 4
Harms of Routine Testing
- False-positive results occur 8 times more frequently than true positives, leading to unnecessary additional testing, patient anxiety, and potential harm from follow-up procedures 1, 2
- Cost and resource waste without corresponding benefit to patient outcomes 1
- Delayed diagnosis and treatment while waiting for unnecessary test results 1
- Patient stress and anxiety from abnormal results that are clinically insignificant 1
The Recommended Alternative
Testing should be selective and guided by clinical evaluation—specifically by findings from the patient's history, physical examination, vital signs, and individual risk factors. 1
Key Principles:
- Order tests only when there is a specific clinical indication based on patient presentation 1
- Consider patient-specific risk factors (age, comorbidities, geographic exposures, medication use) when deciding which tests are appropriate 1
- A thorough history and physical examination should drive test selection, not predetermined protocols 1, 4
Common Pitfall to Avoid:
Do not confuse "routine testing" with "standard of care"—the evidence clearly shows that automatic, non-targeted testing protocols are not beneficial and may cause harm through false positives and unnecessary follow-up 1, 2