In this article:
- Determining frequency of testing
- Communicating guidelines and rationale
- The best ways to share internal information
Even though molecular diagnostics has been around for 20 years now, we are at a relatively early stage of utilization. As you introduce new tests and procedures to your physicians, it can be also be very helpful to recommend testing guidelines. Testing is often expensive and insurance may not reimburse for tests performed outside established guidelines. The lab plays a valuable role in monitoring standards and usage.
Don’t Over Do It
For tests that are run frequently — such as HIV viral load testing — make sure they are done often enough, but not too often. “In many cases, it doesn’t make sense to test certain patients every day. A viral load will not change that much in a day,” said Gregory A. Storch, MD, Director of Infectious Diseases at St. Louis Children’s Hospital. “If a test is being run too often, it can drive up costs.”
Follow Set Guidelines
Physicians may or may not be aware of the guidelines that govern molecular testing. For instance, in the case of hepatitis C, there are widely accepted guidelines that state at what point in time after starting therapy viral load testing (quantitative PCR) should be done (four weeks, 12 weeks, 24 weeks, etc.). For testing after transplantation, there are published international recommendations for cytomegalovirus (CMV) testing.
The lab should be very familiar with testing guidelines and current literature. “If you see things being done that are drastically different, you should bring it to the attention of the physician,” said Dr. Storch.
Tell Them Why
It can be difficult to impose guidelines and change behaviors. According to Dr. Storch, it is best to provide rationale. If you can tell physicians why you are making certain recommendations, they may be more open to suggestions. One way to do this is to show that there is a benefit to patients. For instance, making a diagnosis efficiently may help the patient receive optimal therapy.
Get the Word Out
Be sure to communicate with your key physicians about new tests and guidelines. It is also a good idea to be in contact before a new test is brought in to get their opinions and let them know what’s going to happen. To share lab announcements, you have a few options:
• Lab newsletter or e-newsletter
• Website with helpful FAQs
• Staff bulletins
• Alerts in the computing system
• Communicate through a utilization committee if it exists, or try to create one.
With any internal communications, always let everyone know where to go for further information.