Start the Conversation about Test Ordering
Pathologists are uniquely suited to engage their clinician colleagues and hospital administrators to identify the right test, at the right time, to provide a patient an accurate diagnosis. Whether resulting in squandered laboratory resources, inconclusive data, or even misdiagnosis for the specific patient case, the US health care system faces the critical challenge of optimal use of laboratory testing. Many pathologists regard this as the most pressing issue in the practice of pathology today.
Test Ordering Program for CAP Members
Recognizing this critical issue, the CAP offers the Test Ordering Program. This complimentary members-only resource, compiled by Fellows of the CAP, provides pathologists with essential information about commonly misapplied laboratory tests, often with study data, to address laboratory stewardship through test ordering programs. Content is organized in modules that provide information on test selection, ordering, and interpretation to effect change in an evidence-based manner. The modules help:
- Understand and quantify the problem
- Find system-wide solutions to operational and policy challenges
- Address the issue with clinician colleagues and hospital administrators
- Include questions to reinforce content mastery
- Offer tools for impact analysis and economic value
Get to Know the Modules
The Test Ordering Program modules cover a broad array of tests used by primary care practitioners and specialists. When viewing the modules, viewers may identify analytes that a health care team can target for improvement. Questions are provided for each module to reinforce the lessons learned. The impact analysis portion of the module is designed to guide users through straightforward calculations that can help pathologists demonstrate the economic value of their interventions. Finally, each module has a handout component that complements the full module, which pathologists may share with their clinician colleagues.
Pathologists who use the Test Ordering Program modules may self-claim Continuing Certification (CC) for Improvement in Medical Practice (Part IV) Credit from the American Board of Pathology. Simply complete the self-reporting form and follow its instructions, then add this activity to your CAP education transcript. Click here to download the self-report form.
Biomarkers in Colorectal Cancer: BRAF Testing as a Follow Up to Microsatellite Instability in the Exclusion of Lynch Syndrome
A subset of colorectal cancer (CRC) tumors test positive for the BRAF V600E mutation, whose presence is associated with methylation of MLH1, which correlates with microsatellite instability (MSI). BRAF V600E alone is not useful for excluding Lynch Syndrome. The recommended method is an algorithmic approach to evaluate CRC through immunohistochemistry (IHC) or polymerase chain reaction (PCR) testing.
B-Type Natriuretic Peptide (BNP) or N-Terminal-ProBNP (NT-proBNP)
BNP is frequently used in the evaluation of dyspnea and to assess risk and prognosis of patients with congestive heart failure (CHF). While useful for differentiating pulmonary causes from cardiac causes of dyspnea, repeat inpatient BNP testing may not be valuable.
Cardiac Marker Testing Practices
Appropriate Testing for Hepatitis C Virus (HCV) Infection
Red Blood Cell Folate Testing
Testing serum folate levels is the preferred method for detecting nutritional folate deficiency. Serum folate levels may be preferred over RBC folate testing to assess patient status. This module addresses issues to achieve reliable, conclusive results.
Members only access
Celiac Disease Testing
Increased public awareness of Celiac disease has driven higher testing rates and increased incidence of diagnosis, yet many health care providers agree that many cases remain undiagnosed. Optimal testing, however, remains controversial, especially because of the large number of assays available. An algorithmic approach may support the most reliable diagnoses for Celiac disease.
Members only access
Free Prostate Specific Antigen (PSA) Testing
Total PSA testing is used to test for likelihood of prostate cancer, and until recently prostate biopsy was recommended if the total PSA exceeded 4.0 ng/mL. That could lead to unnecessary biopsies and unwarranted concerns about cancer. Free PSA testing when total PSA is within a specific range is a more reliable method.
Members only access
Repetitive Constitutional Genetic Testing
An individual’s genetic makeup does not change within his/her lifetime, so repeating a constitutional genetic test usually is unnecessary. Applying interventions may avoid retesting, but there are a few rare situations where it may be warranted.
Members only access
Urine myoglobin testing is primarily indicated for diagnosis and risk assessment of kidney injury in patients with rhabdomyolysis. However, this test is best ordered for clinical use and interpretation after the urine dipstick hemoglobin test result is known.
Members only access
Additional Resources for Test Ordering
Want to learn more about this topic? The CAP has several other resources, including scholarly articles and case studies, that can help you develop your knowledge in this important area of laboratory resources management.
- EMR Order Alert Significantly Decreases Vitamin D Testing at Kaiser Permanente by Thomas S. Lorey, MD, FCAP, and Julia Drees, PhD
- Building Brain-to-Brain Bridges from the Clinical Laboratory by Michael Laposata, MD, PhD, FCAP
- Laboratory/Clinician Stewardship Results in Cost Savings and Improved Patient Care by Gary Procop, MD, FCAP
Do you have a case study or example you’d like to share with your colleagues? Email us at firstname.lastname@example.org to tell your story.
- A Q-Probes Study Involving Utilization of Free Prostate-Specific Antigen, Factor V Leiden, and Hepatitis A Serology Tests by Ron B. Schifman, MD, FCAP; Peter L. Perrotta, MD, FCAP; Rhona Souers, MS; Barbara J. Blond, MT(ASCP), MBA.
- Utilization Management by Jordan S. Laser, MD, FCAP
- Smart testing ordering – new program provides the tools by Amy Carpenter Aquino. CAP Today.
- Test Cancellation: A College of American Pathologists Q-Probes Study by Teresa P. Darcy, MD, FCAP; Samuel P. Barasch, MD, FCAP; Rhona J. Souers, MS; Peter L. Perrotta, MD, FCAP. Archives of Pathology and Laboratory Medicine.
- Clinician-friendly tactics slash unwarranted testing by Kevin B. O’Reilly. CAP Today.
- Powering down on excessive test use by William Check, PhD. CAP Today.
- Taking aim at overuse: daily labs, high-cost send-outs by William Check, PhD. CAP Today.
- Improving the Value of Costly Genetic Reference Laboratory Testing with Active Utilization by Jane A. Dickerson, PhD; Bonnie Cole, MD, FCAP; Jessie H. Conta, MS; Monica Wellner, BS; Stephanie E. Wallace, MD, FCAP; Rhona M. Jack, PhD; Joe Rutledge, MD, FCAP; Michael L. Astion, MD, PhD, FCAP. Archives of Pathology and Laboratory Medicine.
- How labs are taming test utilization by Anne Paxton. CAP Today.
- Test utilization: a united front against waste by Anne Paxton. CAP Today.
- Reducing Laboratory Costs through Education-Based Gatekeeping by Kyle Annen, DO, FCAP; LoAnn Peterson, MD, FCAP; and Kurt Reed, MD, FCAP. Archives of Pathology and Laboratory Medicine.
- Duplicate Type and Screen Testing: Waste in the Clinical Laboratory by Margaret L. Compton, MD, FCAP; Penny C. Szklarski, MLT; and Garrett S. Booth, MD, MS, FCAP. Archives of Pathology and Laboratory Medicine.
- Want to Improve Patient Care? Focus on Your Lab’s Test Ordering by Ronald Schifman, MD, FCAP
- How Laboratories Can Improve Test Utilization & Patient Care by Gary Procop, MD, FCAP
Smart Test Ordering
Read how the Test Ordering Program can help you demonstrate the pathologist’s value in improving patient care.