Additional testing of blood samples: reflective versus reflex

Silverstein and colleagues discuss the excess of blood tests performed on hospital inpatients and strategies to reduce adverse effects to the patient and the cost and duration of inpatient stays. 1 They use the term “routine” throughout, which to laboratory staff would mean a non-urgent test within working hours. Here, I presume it describes tests routinely performed on a particular patient’s inpatient pathway. This would be relatively easy to optimise in planned admissions but would be far more difficult in unplanned admissions, when obtaining an early diagnosis is paramount. The authors fail to mention the role of additional testing of initial blood samples taken on admission and whether this testing is reflective (requested by laboratory staff) or reflex (the pathology computer organising extra tests on the index sample). A recent survey across UK NHS biochemistry laboratories found that additional testing occurs across a range of biochemistry tests, although it is variably adopted dependent on the initial abnormal result. 2 This could be incorporated more widely into laboratory practice for a broader range of tests, which would hopefully reduce the repeat blood sampling. Migrating from reflective testing to reflex testing would be a cheap and effective use of the artificial intelligence we hear so much about, using existing IT systems. Trying to reduce