Rational use of blood calcium determinations

• Published in: São Paulo medical journal Vol. 132; no. 4; pp. 243 - 248
• Main Authors: Ferreira-Junior, Mario, Lichtenstein, Arnaldo, Sales, Maria Mirtes, Taniguchi, Leandro Utino, Aguiar, Francisco José Bueno de, Fonseca, Luiz Augusto Marcondes, Sumita, Nairo Massakazu, Duarte, Alberto José da Silva
• Format: Journal Article
• Language: English
• Published: Brazil Associação Paulista de Medicina - APM 01-01-2014; Associação Paulista de Medicina
• Subjects: Algorithms; Blood chemical analysis; Brazil; Calcium; Calcium - blood; Calcium - physiology; Clinical Laboratory Services - economics; Clinical Laboratory Services - utilization; Clinical laboratory techniques; Decision Making; Hospitals, University; Humans; MEDICINE, GENERAL & INTERNAL; Practice management, medical; Practice Management, Medical - economics; Practice Management, Medical - standards; Short Communication; Brazil; Clinical laboratory techniques; Cálcio; Calcium; Blood chemical analysis; Decision making; Tomada de decisões; Practice management, medical; Análise química do sangue; Técnicas de laboratório clínico; Administração da prática médica
• ISSN: 1516-3180; 1806-9460; 1806-9460
• DOI: 10.1590/1516-3180.2014.1324731

This study was motivated by the recent excessive increase in requests for blood calcium determinations and laboratory tests in general, in the Hospital das Clínicas complex of Faculdade de Medicina, Universidade de São Paulo (HCFMUSP). Its aim was to suggest rules for the determination of total and ionized calcium in our intensive care units, emergency department, wards and outpatient services, thus contributing towards improving the quality of medical care and achieving more appropriate use of human and financial resources.
Critical analysis on clinical and laboratory data and the pertinent scientific literature, conducted by the study group for rational clinical laboratory use, which is part of the Central Laboratory Division, HCFMUSP.
The study group reviewed scientific publications, statistics and clinical and laboratory data concerning requests for total and ionized calcium determinations in the settings of intensive care units, emergency department, wards and outpatient services.
From this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed.
Use of the proposed flow diagrams may help to limit the numbers of inappropriate requests for ionized and total calcium determinations, with consequent reductions in the number of tests, risks to patients and unnecessary costs.