RESUMO
INTRODUCTION: Molecular testing to identify targetable driver mutations is the standard of care for patients with advanced-stage non-small cell lung cancer. Recent guideline recommendations by the College of American Pathologists (CAP), International Association for the Study of Lung Cancer (IASLC), and Association for Molecular Pathology (AMP) established a benchmark turnaround time (TAT) target of 10 working days for results to be available to the treating oncologist and ≤ 3 days for specimens to arrive at a commercial testing laboratory if testing is not performed in-house. METHODS AND MATERIALS: To provide insights regarding the pre-testing, post-testing, and testing intervals that constitute the overall TAT target, we performed a detailed workflow analysis. A total of 157 lung cancer specimens were sent out for molecular testing at a commercial vendor from a single academic medical center during the calendar year 2015. RESULTS: Overall, 128 specimens (81.5%) met the recommended 10-working day TAT, with a median total TAT of 9 weekdays (mean ± standard deviation, 9.17 ± 4.15 days). The pre-testing interval was ≤ 3 days for 146 specimens (93.0%), and the post-testing reporting interval was < 1 day for 116 cases (73.9%). The TAT variance was not related to intrinsic specimen characteristics. CONCLUSION: Overall, the findings indicated that the CAP/IASLC/AMP TAT guideline recommendations are feasible for most lung cancer specimens when a streamlined system is in place.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/genética , DNA de Neoplasias/análise , Testes Genéticos/estatística & dados numéricos , Neoplasias Pulmonares/genética , Manejo de Espécimes/estatística & dados numéricos , Quinase do Linfoma Anaplásico , Análise Mutacional de DNA , Receptores ErbB/genética , Estudos de Viabilidade , Feminino , Testes Genéticos/normas , Humanos , Hibridização in Situ Fluorescente , Masculino , Terapia de Alvo Molecular , Guias de Prática Clínica como Assunto , Proteínas Tirosina Quinases/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Receptores Proteína Tirosina Quinases/genética , Estudos Retrospectivos , Manejo de Espécimes/normas , Fatores de Tempo , Fluxo de TrabalhoRESUMO
Results from reference laboratories are often not easily available in electronic health records. This article describes a multi-pronged, long-term approach that includes bringing send-out tests in-house, upgrading the laboratory information system, interfacing more send-out tests and more reference laboratories, utilizing the "miscellaneous assay" option offered by some reference laboratories, and scanning all remaining paper reports from reference laboratories for display in the electronic health record. This allowed all laboratory results obtained in association with a patient visit, whether performed in-house or at a reference laboratory, to be available in the integrated electronic health record. This was achieved without manual data entry of reference laboratory results, thereby avoiding the risk of transcription errors. A fully integrated electronic health record that contains all laboratory results can be achieved by maximizing the number of interfaced reference laboratory assays and making all non-interfaced results available as scanned documents.
Assuntos
Sistemas de Informação em Laboratório Clínico , Sistemas de Gerenciamento de Base de Dados , Registros Eletrônicos de Saúde/estatística & dados numéricos , Humanos , Informática Médica/métodosRESUMO
OBJECTIVES: To control the cost of reference laboratory testing, to ensure that its usage is medically appropriate, and to review the contribution of reference testing to patient care at our institution. METHODS: A multidisciplinary institutional committee was convened to manage the utilization of reference testing. A subset of tests was designated to be reviewed in real time by a team of clinical pathologists in consultation with clinical subject matter experts. RESULTS: Twelve percent of testing requests, accounting for approximately 18% of send-out costs, were determined to be clinically unnecessary or would not produce actionable results at that point during that patient's care and were therefore not performed. This intervention, combined with insourcing of frequently requested tests, resulted in a reduction in the costs of reference testing to less than half of that predicted by the rate of growth from 2005 to 2009. Molecular diagnostic tests displayed a higher cost per test than other forms of testing but had a similar degree of clinical impact. CONCLUSIONS: Formal prospective review of reference laboratory testing requests resulted in substantial cost containment and improved the efficiency of patient care.