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Test Ordering Program
Lead your organization’s laboratory stewardship to drive operational excellence, achieve diagnostic confidence, and ensure the best patient care.
Many health care networks expect their laboratories to provide exemplary testing results with limited resources. If your laboratory's tight operating budget and staff shortage demand detailed attention to operational efficiency, you are not alone. The Test Ordering Program gives CAP customers essential information about commonly misapplied laboratory tests, often with study data, to address laboratory stewardship through test ordering patterns. The content is available to laboratories or health systems participating in CAP accreditation and proficiency testing and is organized in modules that provide information on test selection, ordering, and interpretation to effect change in an evidence-based manner.
The modules can help you:
- Identify ways to use limited resources wisely
- Build a laboratory stewardship program
- Review testing patterns for efficacy and utility
The Test Ordering Program addresses laboratory testing across major scientific disciplines, with new modules added periodically. Each module provides analytical tools and expert-reviewed content to enhance your understanding of the latest recommendations, as well as informative reference sheets written specifically to share with your clinician colleagues. Although the topics vary, all aim to assist the laboratory in its quest to provide optimal patient care, with an eye toward achieving the most effective testing practices.
Lead your organization’s efforts in laboratory stewardship to drive operational excellence, achieve diagnostic confidence, and ensure the best patient care with the modules below.
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Heparin-Induced Thrombocytopenia Testing
Limiting HIT testing to those patients with a greater likelihood improves the predictive value of immunoassay testing. Developing a pre-test predictive scoring system can ensure optimal utilization of laboratory and pharmacy resources.
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Lipase in the Diagnosis of Acute Pancreatitis
Acute pancreatitis, an inflammation of the pancreas, is one of the most frequent gastrointestinal causes of hospital admissions. Lipase is preferred over amylase as a diagnostic biochemical marker when diagnosing acute pancreatitis, as explained in this module.
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Testing for Carcinoid Syndrome
Several biomarkers may be used to evaluate patients with suspected neuroendocrine tumors. Patient and testing conditions can affect testing, however, and optimal laboratory testing can help avoid interpretative error and accurate diagnosis for patients with carcinoid syndrome and these tumors.
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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.
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Cardiac Marker Testing Practices
Cardiac troponin (cTn) is often cited in guidelines as the preferred marker for acute myocardial injury (AMI). The evaluation methodology in this module may be applied to other markers of AMI such as creatine kinase MB (CK-MB), too.
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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.
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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.
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5, 10-Methylenetetrahydrofolate Reductase (MTHFR)
Often mistakenly ordered for patients at risk for thromboembolism, coronary heart disease, and recurrent pregnancy loss, MTHFR may have utility for other clinical indications.
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Genetic Hemochromatosis
A common hereditary disorder that can lead to severe complications from iron toxicity. Diagnosis of the most common form comes from genotyping the HFE gene. Selection of appropriate criteria for HFE genetic testing and accurate interpretation of test results to inform treatment are important to optimize use of this test.
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Contact Information
Please direct questions, comments, or success stories to testordering@cap.org or call 800-323-4040.