• Mario Ferreira-Junior, Arnaldo Lichtenstein, Maria Mirtes Sales, Leandro Utino Taniguchi, Francisco José Bueno de Aguiar, FonsecaLuiz Augusto MarcondesLAHospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil., Nairo Massakazu Sumita, and Alberto José da Silva Duarte.
• Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
• Sao Paulo Med J. 2014 Jan 1; 132 (4): 243248243-8.

Context And ObjectiveThis 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.Design And SettingCritical 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.MethodsThe 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.ResultsFrom this critical analysis, clinical decision flow diagrams aimed at providing guidance for ordering these tests were constructed.ConclusionsUse 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.

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