CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Charna Albert
May 2020—Like a top 40 radio hit, test utilization is a topic that can sometimes seem to be overplayed. But the COVID-19 pandemic brings into sharp relief its importance.
“What we’ve seen is organizations that have more mature test utilization efforts in place may be better able to handle these crises,” says Peter L. Perrotta, MD, professor and chair of pathology, anatomy, and laboratory medicine at West Virginia University School of Medicine and director of pathology services, West Virginia University Health System.
Laboratories have long been looked to for guidance on optimal respiratory virus testing for outpatients, he says. Now the guidance is needed for inpatients. “Patients are entering our organizations and they’re requiring COVID-19 and other respiratory virus testing, and leadership is looking to us to decide when these tests are going to be used.”
All the more reason for laboratories to take note of a new Q-Probes test utilization study set to get underway in June.
Dr. Perrotta
“Inpatient Test Utilization and Volume Benchmarking,” written by Ron B. Schifman, MD, and Dr. Perrotta, as a program of the CAP Quality Practices Committee, will help laboratories determine whether their inpatient testing practices are in line with those of their peers, or whether they could benefit from implementing targeted stewardship interventions. Enrollment is open now for the study to be delivered June 8, but the study can be ordered through July 27.
“The idea is you can benchmark your test volume,” says Dr. Schifman, pathologist at the Southern Arizona VA Health Care System and professor of pathology, University of Arizona College of Medicine. Laboratories enrolled in the study will be asked to provide their annual inpatient test volumes for 50 commonly ordered analytes. “Based on the distribution of results, we’ll be able to provide feedback to laboratories about their relative test volumes. Let’s say, for example, a laboratory reports 10 times higher volume of a specific test per inpatient day compared with the median of its peers. That might indicate an opportunity for the laboratory to evaluate potential reasons, such as menu configuration, standing orders, or other factors that could be addressed for improvement,” Dr. Schifman says. Results from the Q-Probes will also inform laboratories about inpatient test volumes that are similar to those of their peers and perhaps not worth further evaluation. The CAP will provide recommendations to participants based on the study’s findings.
Says Dr. Perrotta, “Many organizations are having difficulty monitoring for proper utilization of the analytes that we have included in this Q-Probes. To be honest, there aren’t specific guidelines for most tests, and guidelines for how a test is used are constantly changing.” He cites procalcitonin as an example: “With the guideline changes, laboratories see surges in their inpatient test volume, and they need to make sure procalcitonin use is consistent with the most current guidelines.” Heparin-dependent antibody tests and the serotonin release assay, he says, are other analytes in the study that are sometimes overused.
CK-MB, too, can be a problem. “We’ll probably see laboratories that don’t measure CK-MB at all or very rarely,” Dr. Schifman says, “and others where it’s pretty much the standard practice.” For labs where CK-MB use is still high, peer comparisons may help support better compliance with current testing recommendations, he says.
Dr. Schifman