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Optimal Testing: High Impact Recommendations

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.

Before making any changes, administrators should consult their laboratory director to make sure the changes are right for their patient population.