Laboratory News [Volume 3 Issue 2 – Feb 2016]
In this issue Page 1: Test Utilization Helicobacter Antibody Test Page 2: Compliance Informed Consent Required Page 3 Chemistry News Ammonia Testing Hematology News Pathologist Review Immunochemistry News Chlamydia Antibody Testing Page 4 Microbiology News Antimicrobial Stewardship Discontinued Tests Trichomonas collection Page 5 Toxicology News Urine Conf. Updates General Information Courier 2015 Review Lockbox Tips Please email Laboratory Services with any questions or concerns or to receive this newsletter via email.
Laboratory Call Center & Specimen Pick Up:
616.774.7721 Test Catalog
Monthly updates and information from Spectrum Health Regional Laboratory
Improving Test Utilization Helicobacter Antibody Testing Effective March 1, 2016, Mayo Medical Laboratories will no longer perform any Helicobacter Antibody (IgG, IgM, or IgA) testing. The Mayo Clinic has determined that Helicobacter antibody testing has a poor predictive value, and also has poor clinical sensitivity and specificity. While a negative antibody result suggests the absence of prior Helicobacter exposure, a positive result is not predictive of active Helicobacter infection. Furthermore, since antibody levels may remain positive for years following resolution of infection serologic testing cannot be used to distinguish active from past infection or document eradication of Helicobacter infection following treatment. See the full text of a recent Mayo Medical Laboratories Communique article on Helicobacter testing methods for further information on the various available tests for Helicobacter infection. Effective as of the above date, the Helicobacter pylori Antibody IgM and Helicobacter pylori Antibody IgA tests will no longer be available through the Spectrum Health Laboratory. The Helicobacter pylori Antibody IgG test (#8596), which is performed in house, will continue to be available until further notice, but may be subject to further review at a later time. Some third party payers are now considering Helicobacter antibody tests to be medically unnecessary and no longer reimbursing for them. The Helicobacter pylori breath test (#3013, available from the Spectrum Health Laboratory) and the Helicobacter pylori Antigen, Stool test (#4307, available as a send out to Mayo Medical Laboratories) are now considered the primary recommended tests for the diagnostic evaluation of suspected Helicobacter infection. Refer to the linked Mayo diagnostic algorithm for further information on recommended approaches to Helicobacter pylori diagnostic testing. Any questions concerning these changes in Helicobacter pylori testing may be directed to Dr. Richard Horvitz in the Pathology Department at (616) 267-2785 or
[email protected]
New centralized laboratory orders fax line: One Fax (616) 774-7696 Any laboratory testing order can be faxed to (616) 774-7696 and that order will be accessible from any Spectrum Laboratory Draw Site in the Grand Rapids, Big Rapids and Gerber (Fremont) area. Laboratory News | February 3, 2016
1
Compliance Informed Consent Requirement A1AT Proteotype S/Z and Alpha Globin Gene Analysis genetic tests now require informed consent along with those genetic tests that already require it (see below). Spectrum Health Information Services has added an Ask at Order Entry question (AOE) “Has signed informed consent been obtained from the patient: Yes/No” to these tests. If the answer to this question is no, testing will either not be drawn (outpatient) or cancelled until informed consent is obtained by the ordering provider. Tests which require informed consent: A1AT Proteotype S/Z Alpha Globin Gene Analysis Alpha1AT Defic Profile Angelman/Prader Willi (15q11-q13) by FISH Angelman/Prader Willi mPCR CF Carrier Screening by Sequenom CF DNA CF Gene Sequencing to MAYO Chromosomal Microarray (CGH) Chromosome Analysis Constitutional Chromosome Analysis POC Chromosome Analysis Prenatal Factor V Leiden DNA Analysis FISH for aneuVysion FISH for Common trisomies in POC FISH for DiGeorge FISH for Down syndrome FISH for Major trisomies FISH for Miller-dieker FISH for Prader-willi FISH for Smith-Magenis FISH for Subtelomeres
FISH for Trisomy 21 FISH for Turner FISH for Williams FISH for Wolf-hirschhorn FISH for XX and XY FISHAneuTCPanel FISHAneuVysion FISHDiGeorge FISHDownSyn FISHMillerDieke FISHPraderWilli FISHSmithMageni FISHSubtelomeres FISHWilliams FISHWolf FISHXXYYSRY Hemochromatosis DNA Huntington's Disease Molecular Analysis MTHFR C677T Prothrombin G20210A Send Out CMA
NOTE: The Spectrum Health Regional Laboratory is reviewing all test requests not performed on site (send out) to determine if there is an available in-house alternative and if the result will significantly alter patient diagnosis, prognosis or treatment. All reviews are being done in collaboration with the ordering providers on a case by case basis. We need your support in this process so that we can improve our service through improved test utilization. Laboratory News | February 3, 2016
2
Chemistry Department News Ammonia, NH3 As of March 1, 2016, Spectrum Health Laboratory, Grand Rapids, will no longer provide services for outpatient Ammonia testing (#8074). Since the specimen must be to the laboratory within 15 minutes, it is not recommended for outpatient draw. Prior to order, approval of outpatient ammonia testing must be obtained from Dr. David Alter or the Clinical Pathologist on-call. Inpatients at Spectrum Health Butterworth and Blodgett Hospitals, as well as outpatients that are drawn at 35 Michigan Draw Site are exempt. If your patient needs an outpatient ammonia test, please have them drawn at the 35 Michigan Street Draw Site. Any questions concerning these changes may be directed to Dr. David Alter in the Pathology Department,
[email protected].
Hematology Department News Pathologist Review, Reason for Review Pathologist review of peripheral blood smear (#8367) will have an additional required field to complete upon ordering. We are striving to improve our test utilization, inter-provider communication, and accurate and timely result reporting. Providers will see a choice of the top 10 to 15 reasons for review, including such reasons as “anemia evaluation” and “look for blasts”. An option for “other, see comment” is available for any free text comments to the pathologist. This change is anticipated to begin for all electronic ordering of this test on February 4, 2016 Any questions concerning these changes may be directed to Dr. Jennifer Stumph, Director of Hematology, at
[email protected] or 616-267-2660.
Immunochemistry Department News Chlamydia Antibody Testing Changes The Spectrum Health Laboratory is no longer performing the Chlamydia Antibody Screen test (#8874). The reagent the Laboratory was using for this test is no longer available. Specimens for Chlamydia antibody testing will now need to be sent to Mayo Medical Laboratories for their Chlamydia Serology panel (#37). This panel includes IgG and IgM antibodies to Chlamydia pneumoniae, Chlamydia trachomatis, and Chlamydia psittaci. It should be noted that cross reactivity commonly occurs between these different Chlamydia species, especially for IgM antibodies. Infection by a particular organism generally yields IgG titers higher than those for non-infecting organisms. Any questions concerning these changes may be directed to Sue Koekkoek, Medical Technologist in the Immunochemistry Department at (616) 267-2770 or to Dr. Richard Horvitz in the Pathology Department at (616) 267-2785 or
[email protected]. Laboratory News | February 3, 2016
3
Microbiology Department News Clostridium difficile Toxin, PCR testing In order to increase quality of care for our patients and decrease the overuse of antibiotics, when ordering Clostridium difficile Toxin, PCR, remember these important notes! Only test symptomatic patients; diarrhea with 3 or more liquid (i.e. watery), loose, unformed stools in 24 hours or less. Testing of asymptomatic patients is not clinically useful. For example, testing of asymptomatic patients will only detect colonization and not disease. Treatment of colonization is not possible or recommended. Testing for “Test of Cure” is also inappropriate. It only results in unnecessary treatment and creates anxiety for the patient and providers. Do not test patients who are having liquid/loose stools for known reasons (i.e. laxatives, bowel prep). Only one specimen is necessary for detection of toxigenic C. difficile. If PCR is negative, repeat testing within 7 days is not recommended. Test information has not been established for patients less than 2 years of age. Up to 50% of infants less than 2 years asymptomatically carry C. difficile and its toxins. Any formed or soft stools will be immediately rejected and testing will be canceled. Only liquid stools should be sent for laboratory testing. Please refer to this article provided by Infectious Disease Specialist, Dr. David Dobbie: Clostridium difficile infection in adults: Clinical manifestations and diagnosis Lamont, J Thomas, M.D. UpToDate. December 2015 If you cannot access this article, a version can be emailed to you. Please submit a request to
[email protected].
Discontinued Microbiology Testing: Body Fluid Culture w/o gram (#158) – Please order Body Fluid Culture w/Gram (#166) Miscellaneous Culture w/o gram (#157) – Please order Miscellaneous Culture w/Gram (#8890) Tissue Culture w/o gram (#161) – Please order Tissue Culture w/Gram (#8886) Wound Culture w/o gram (#162) – Please order Wound Culture w/Gram (#167)
Trichomonas, Wet Prep (eSwab) Trichomonas, Wet Prep (#4201) has new collection instructions. Please review the online laboratory catalog prior to collecting the specimen.
Flu season is coming! Make sure you know how to collect these specimens: How to collect: Nasopharyngeal Collection How to collect: Throat Swab Collection How to collect: eSwab Collection How to collect: UTM Viral Media How to collect: Microbiology Quick Guide Laboratory News | February 3, 2016
4
Toxicology Department News Urine Confirmation Updates (repeat) The Toxicology Laboratory Department has modified its reporting of urine drug confirmation results. Please review last month’s newsletter or for more information please consult the online laboratory catalog or contact the Toxicology Department.
General Information 2015 Courier Department, Year in Review 2015 was a busy year for the Laboratory Courier Department in Grand Rapids! 6,391 supply orders were filled by the couriers and delivered to our clients, more than any other year. 19,706 stat specimen calls were placed and picked up by our couriers, more than any other year. The couriers traveled about 788,111 miles in 2015, more than any other year. That is more than 3 trips to the moon. Actually it is a trip to the moon, then back to earth and then back to the moon. (Unless you started at the moon.) Either way, the courier department went to the moon and back a couple of times. If you remember the article from July 2015, we had a courier vehicle reach 500,000 miles! By the time she retired, she had 513,942 miles. This is an all-time record with the highest mileage! The year started with the Courier Supervisor, Joel Boorsma, working with the Courier Quality Improvement Committee to re-build their training program. That program became a well-organized and detailed training program by the end of 2015. They had 7 new couriers successfully go through the process. As part of this training program they also used the opportunity to re-train all of their couriers. This is now called route certification. The courier supervisor spends a day with every courier on staff and evaluates how they do their route. He has completed 25 of these certification ride-alongs! We hope this gives you a little insight to our courier department and our process improvements to help keep your patients’ specimens safe! “With everything we accomplished in 2015 described above and not described above, this department has a lot to be proud of. For me, it is the 40 couriers and our coordinator who have helped make this department something to be proud of in 2015. Their commitment, dedication and professionalism in their job are well above expectations. They drive through the summer heat, winter snow and have to deal with the craziest of all drivers while smiling and continuing on their way.” – Joel Boorsma, Courier Supervisor
Winter Lockbox Tips! To maintain optimal specimen integrity, Spectrum Health Laboratory requests that you load your lockbox properly for winter weather temperatures. Please follow the diagram on the right to prevent freezing of specimens. Frozen specimen should not be left in the lockbox for after-hours pickup. These tests may be better preserved in the office freezer until the next day’s courier pickup. Request for specimen pickup should be made to the Laboratory Call Center at 616.774.7721. Laboratory News | February 3, 2016
5
