A retrospective audit of send-away haematological malignancy diagnostic tests at a District General Hospital highlights the importance of local guidelines to reduce inappropriate testing

By:

Aiken, L.A

Contributor(s):

Publication details: 2015Uniform titles:

British Journal of Haematology

Online resources:

Click here to access online

Summary: The yearly expenditure on send-away samples for haematological malignancy diagnostic (HMD) testing at our institution increased from 37,583 to 89,246 from 2012 to 2013. Immunophenotyping, cytogenetics, BCR-ABL quantitation and JAK-2 testing accounted for >95% of the total expenditure. The aim was to evaluate reasons for the increase in HMD tests and whether testing was in line with local guidance from 2006. We conducted a retrospective audit of send-away HMD tests over a 3-month period, their clinical indications and appropriateness of testing against local guidance. Sixty-three patients evaluated had 102 tests requested on peripheral and/or bone marrow. Forty-three of 49 (87%) immunophenotyping tests, and all 7 (100%) BCR-ABL tests were appropriate. Only 17 of 36 (47%) cytogenetics tests fulfilled the local guidance. Ten JAK-2 samples (not included on the 2006 guidelines) were requested, of which 3 (30%) were in patients who did not fulfil the BCSH criteria for polycythaemia and thrombocytosis investigations. Overall 28% of HMD tests were inappropriate, representing a projected 41,500 per annum cost. Trainees highlighted that they took extra samples 'just in case' and these were often sent away even if not indicated. Updated local guidelines were drafted, in line with local consultants, based on clinical utility and taking national guidance into account. It was also recommended that consultants support trainees by documenting which bone marrow tests are required. Following these implementations, a re-audit was undertaken. 98 tests were recorded in 77 patients, compared to 102 for 63 in the previous audit. Overall, 88% of tests were in line with the new guideline. Consultants did not express any concerns that patient care was affected by fewer tests being performed. This audit highlights that local guidance and support of junior staff on the judicious use of expensive HMD tests can better utilise NHS resources without compromising patient care. [Conference abstract]

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NMUH Staff Publications

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The yearly expenditure on send-away samples for haematological malignancy diagnostic (HMD) testing at our institution increased from 37,583 to 89,246 from 2012 to 2013. Immunophenotyping, cytogenetics, BCR-ABL quantitation and JAK-2 testing accounted for &gt;95% of the total expenditure. The aim was to evaluate reasons for the increase in HMD tests and whether testing was in line with local guidance from 2006. We conducted a retrospective audit of send-away HMD tests over a 3-month period, their clinical indications and appropriateness of testing against local guidance. Sixty-three patients evaluated had 102 tests requested on peripheral and/or bone marrow. Forty-three of 49 (87%) immunophenotyping tests, and all 7 (100%) BCR-ABL tests were appropriate. Only 17 of 36 (47%) cytogenetics tests fulfilled the local guidance. Ten JAK-2 samples (not included on the 2006 guidelines) were requested, of which 3 (30%) were in patients who did not fulfil the BCSH criteria for polycythaemia and thrombocytosis investigations. Overall 28% of HMD tests were inappropriate, representing a projected 41,500 per annum cost. Trainees highlighted that they took extra samples 'just in case' and these were often sent away even if not indicated. Updated local guidelines were drafted, in line with local consultants, based on clinical utility and taking national guidance into account. It was also recommended that consultants support trainees by documenting which bone marrow tests are required. Following these implementations, a re-audit was undertaken. 98 tests were recorded in 77 patients, compared to 102 for 63 in the previous audit. Overall, 88% of tests were in line with the new guideline. Consultants did not express any concerns that patient care was affected by fewer tests being performed. This audit highlights that local guidance and support of junior staff on the judicious use of expensive HMD tests can better utilise NHS resources without compromising patient care.&nbsp;[Conference abstract]

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