"Customers Like You Also Ordered …".

Abstract

Inappropriate laboratory test utilization is a significant challenge for clinical laboratories attempting to improve patient care while minimizing waste of resources.1 Overordering of tests is a high-priority target for laboratories due to external pressures to identify and prevent unnecessary health care expenses and phlebotomy. Fortunately, it is relatively easy for laboratories to measure the volumes of tests that have been performed and to monitor changes in volume in response to initiatives designed to reduce overuse. Underordering of tests, on the other hand, is a more formidable challenge. There are fewer economic incentives to recommend additional testing, and it is more difficult to predict an event that does not happen (ie, a test that should have been performed but was not, one that may have guided clinical decision-making to improve a patient’s care . . . if only it had been ordered at the right time). In this issue of AJCP, Pearson et al2 present a quality improvement initiative at a tertiary medical center designed to facilitate the laboratory evaluation of monoclonal gammopathies (MGs) by tackling an example of underordering: serum free light chain (sFLC) testing. Current expert guidelines recommend the use of sFLC in conjunction with serum protein electrophoresis (SPEP) testing for the initial screening and diagnosis of MGs due to the superior sensitivity and prognostic value of sFLC over SPEP alone.3 Unfortunately, sFLC testing is often not ordered when indicated. The reasons for this underordering are not known, but they may include lack of awareness by ordering providers or lack of adoption by clinical services of recently published guidelines.