The Association for Diagnostics & Laboratory Medicine (formerly AACC) has summarized several of its Optimal Testing Guides into High Impact Recommendations. These actionable recommendations are geared towards hospital administrators who want to improve patient care and the bottom line. Please visit the Optimal Testing pages for each individual test for more information.
Amylase: Serum lipase is superior to serum amylase in the diagnosis and monitoring of acute and chronic pancreatitis and other pancreatic diseases. Serum amylase testing should not be offered for assessment of pancreatic disease at facilities that offer serum lipase tests. Testing for both lipase and amylase is clinically redundant, and serum amylase can safely be eliminated from laboratories that perform serum lipase testing.
CKMB: Cardiac troponin (cTnI or cTnT) testing is superior to CKMB in the diagnosis and management of acute myocardial infarction. CKMB should not be offered for assessment of acute coronary syndrome at facilities that offer cardiac troponin testing. Elimination of CKMB from the testing menu could produce financial savings without compromising patient care.
Fetal Lung Maturity: Fetal Lung Maturity (FLM) testing, assessed via Lecithin/Sphingomyelin ratio, Phosphatidylglycerol, Disaturated Lecithin, Lamellar Body Count, and Fluorescence Polarization, is not recommended in any clinical scenarios involving pregnant women to aid in timing of delivery. FLM testing should not be offered to justify preterm or early-term delivery, and there is no clinical utility of the individual tests. Elimination of FLM panels and the individual tests from the testing menu could produce significant financial savings without compromising patient care.
Homocysteine: Measurement of total plasma homocysteine is recommended in individuals with suspected or confirmed inborn errors of methionine metabolism which cause hyperhomocysteinemia. It also may be useful in the diagnosis of patients with suspected deficiencies of vitamin B12 or folate. Homocysteine should not be measured for routine screening for cardiovascular disease risk.
Serum Free Lights Chains: Measurement of serum free light chains with calculation of kappa to lambda ratio is recommended to aid in the diagnosis and/or monitoring of patients with monoclonal-protein related disorders, including multiple myeloma, Waldenstrom macroglobulinemia, and amyloidosis. Serum free light chain ratio alone is not diagnostic or confirmatory of disease, and should be interpreted in the context of other laboratory tests and clinical findings associated with monoclonal-protein related disorders.
Before making any changes, administrators should consult their laboratory director to make sure the changes are right for their patient population.
