Test Utilization

Posted on Aug 1, 2018 in Announcements | 0 comments

A new Alta Bates Summit Test Utilization Committee has been formed to promote strategies for appropriate laboratory testing, with the goal of providing high quality, cost effective patient care.  The initiative champion is Dr. Alejo Santa Cruz, with multi-disciplinary committee participation by laboratory/pathology, emergency medicine, neurology and infectious disease representatives.

Most effective test utilization strategies rely on EHR clinical decision support (CDS) rules to alert providers about unnecessary testing.  Given the challenges of implementing Epic CDS rules system-wide, our initial efforts will be focused on the following provider-driven strategies:

  1. Frequency Limitation on Common Tests

Daily lab orders without a default occurrence are used in some Epic order sets.  Since providers will probably not modify the occurrence, this may lead to inappropriate test utilization (i.e., daily testing during entire hospitalization).  The Epic SME groups have been asked to review these order panels and add a default occurrence of no more than 3 days, unless there is a clinical reason to justify a longer time frame.

  1. Obsolete Testing

The following tests are considered obsolete.  Consider a more appropriate alternative test to improve quality of care provided.

Obsolete Test 2017 Test Volume Alternate Test Comment
Bleeding Time (BT) Ashby:         4

Summit:  374

 

·  Detailed clinical history (family, surgical, meds) is best pre-op screening “test”

o No bleeding hx with prior procedure à don’t screen

o No bleeding hx & no prior procedure à +/- screen

o Suspicion or bleeding hx à screen (PT/PTT/PLT/FIB)

·  Platelet Function Assay (PFA)

·   BT & PFA do not predict surgical bleeding in patients with a negative bleeding history.

·   Use the HAS-BLED bleeding risk tool

 

Myoglobin 24 Troponin Troponin is more specific and rises as early as or earlier than myoglobin after AMI.
Amylase 1,107 Lipase Lipase has improved specificity and similar sensitivity as amylase
  1. Commonly Misordered Tests

Be alert to the following “look-alike” and other tests, which may be incorrectly ordered:

1,25-Dihydroxyvitamin D Vitamin D (1,25-dihydroxy) is NOT useful in routine screening for vitamin D deficiency.  Consider as an alternative to order Vitamin D, 25-hydroxy.
Beta-2-microglobulin Verify that you want “Beta 2 microglobulin” and not “Beta 2 glycoprotein I IgG” or “Beta 2 glycoprotein I IgM”.  Beta 2 glycoprotein is ordered mainly for hypercoagulable workup.
Protein C Resistance Verify that you want Protein C and not C-Reactive Protein (CRP)
Creatine Verify that you want “Creatine” and not “Creatinine”
Manganese Verify that you want “Manganese” and not “Magnesium”.
Paraneoplastic Autoantibody Panel, Serum The paraneoplastic autoantibody evaluation panel is intended for workup of patients with paraneoplastic neurologic symptoms AND malignancy.  Screening for unexplained neurologic symptoms in the absence of reasonable suspicion for malignancy has low diagnostic yield and leads to false positives. Individual autoantibodies, such as NMDA Receptor antibodies, are available.  Consider if this panel is clinically indicated for the patient.

Please let us know if you have any questions.

ABSMC Test Utilization Committee
Alejo Santa Cruz, MD
Annette Shaieb, MD

 

Leave a Reply

Your email address will not be published. Required fields are marked *