SUN-233 Testosterone Ordering Processes in a Military Health System

Background: Testosterone laboratory evaluation in men not taking exogenous testosterone is most accurate when performed in the early morning near the time of waking. A process improvement project was created to review testosterone ordering and collection practices in the San Antonio Military Health System (SAMHS). Method: A retrospective review of male testosterone testing during a three month time period in late 2017 was completed, assessing laboratory collection times and rates of repeat testosterone testing. Prescriptions of testosterone therapy in the three month evaluation period or during the four months prior to the evaluation period were also reviewed. Cost for each testosterone test available to order in the SAMHS was also assessed. Results: During the assessment period, 1,358 men underwent testosterone testing. The laboratory performed 2,328 individual testosterone tests. Most (98.3%) men did not have testosterone prescriptions during this three month period or in the preceding four months. There were 865 (64.8%) men not on testosterone therapy who had laboratory collections prior to 10:00 AM; 109 (12.6%) of them underwent repeat testing during the evaluation period. The additional 470 (35.2%) men who were not on testosterone therapy had laboratory collections after 10:00 AM; 55 (11.7%) of them underwent repeat testing during the evaluation period. The rate of repeat laboratory testing did not differ significantly based on time of initial testing. Patients with testosterone prescriptions completed laboratory collection prior to 10:00 AM about half of the time (47.8%) and were less likely to have repeat laboratory evaluation (26.1%). The most commonly ordered laboratory tests were: total testosterone ($1.36), testosterone with indices ($2.89), free testosterone ($32.00), and the testosterone evaluation panel ($32.00). Total testosterone was ordered most frequently with an estimated total cost of $1,200 for the evaluation period. The more expensive testosterone panel testing was ordered 35.7% of the time for a total estimated cost of $16,300. Conclusions: Testosterone laboratory testing was collected after 10:00 AM in one third of cases, which can significantly impact its interpretation and create waste for the health care system. The SAMHS would benefit from a performance improvement project that limited laboratory collection of testosterone after 10:00 AM.