Context: Coronavirus disease 2019 (COVID-19) changed the dynamics of healthcare delivery, shifting patient priorities and deferring care perceived as less urgent. Delayed or eliminated care may place patients at risk for adverse outcomes.

Objective: To identify opportunities for laboratory test stewardship to close potential gaps in care created by the COVID-19 pandemic.

Design: The study was a retrospective time series design examining laboratory services received before and during the COVID-19 pandemic at a large metropolitan health system serving women and children.

Results: Laboratory test volumes displayed three distinct patterns: (1) a decrease during State lockdown, followed by near-complete or complete recovery, (2) no change, and (3) a persistent decrease. Tests that diagnose or monitor chronic illness recovered only partially (e.g., HbA1c initially declined 82% (2232 for April 2019 to 452 for April 2020), and there was a sustained 16% drop (28-day average 117 at 8/30/2019 to 98 at 8/30/2020) four months later. Blood lead dropped 39% (2158 for April 2019 to 1314 for April 2020) and remained 20% lower after four months.

Conclusions: The pandemic has taken a toll on patients, practitioners, and health systems. Laboratory professionals have access to data that can provide insight into clinical practice and identify pandemic-related gaps in care. During the pandemic, the biggest patient threat is underuse, particularly among tests to manage chronic diseases and for traditionally underserved communities and people of color. A laboratory stewardship program, focused on peri-pandemic care, positions pathologists and other laboratory professionals as healthcare leaders with a commitment to appropriate, equitable, and efficient care.

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Author notes

Department of Pathology and Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX (Singh, Dowlin, Chong); Amazon.com, Inc, Seattle, WA (Nakamoto); Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA (Hilborne); Quest Diagnostics, Secaucus, NJ (Hilborne)

Dr. Hilborne is an employee of Quest Diagnostics and owns stock. The other authors have no relevant financial interest in the products or companies described in this article.