Effective November 5th, the following test order names will be modified. These changes have been made to enhance clarify regarding the testing performed. In all cases, prior Cerner names are set as aliases that direct to the new Epic order names.
There has been a minor change to the influenza testing methods performed by the Spectrum Health Regional Laboratory (SHRL) to improve the accuracy and timeliness of patient results, while simplifying the ordering process for providers. In past years during respiratory illness season, the lab performed influenza rapid antigen testing due to its low cost and rapid turnaround time, with negative specimens reflexed to PCR for confirmatory testing. Approximately 85% of specimens tested by a rapid antigen method typically reflexed, with those patients charged for performing both tests.
As of July 11, 2017, Spectrum Health Regional Laboratory will offer Streptococcus pneumoniae urine antigen testing. This testing is currently sent to Mayo Medical Laboratories. By bringing testing in-house, result turnaround time will be improved by 1 day, testing will be available 7 days per week (instead of Monday – Friday), and testing can be offered at a reduced charge to our patients.
On June 27th, the name of the current order “Respiratory (non-sputum) Culture without Gram stain” will change to “Throat Culture Comprehensive.” All other specimen collection details and culture workup will remain the same. Given the fact that there are currently several similarly named tests, this change is being made to reduce confusion regarding test selection and to clarify acceptable specimen types.
As of May 2, 2017, Spectrum Health’s Infection Control & Prevention department has declared the system to be officially within “Non-Influenza Season” based on a return to baseline prevalence at both the local and state levels.
Spectrum Health Regional Laboratory is preparing to switch Clostridium difficile testing methods from solely using a molecular approach to a 2-step algorithm utilizing an Enzyme Immunoassay (EIA) that detects two C. difficile-specific proteins (glutamate dehydrogenase or GDH, and A/B toxin) with indeterminant EIA specimens reflexed to PCR (see flowchart below). It is estimated that approximately 90% of patients tested will be resolved by EIA and not require reflexive PCR testing. This algorithm decreases expenses to the patient by an average of 65% as compared to current testing without sacrificing result quality. Specimens will be batched for EIA testing at a frequency to ensure that results are available within 6 hours of receipt by the laboratory so that proper contact isolation precautions may be initiated when indicated.
As of January 30th, 2017 the test for Fecal Leukocytes will be discontinued and replaced with testing for Fecal Lactoferrin.
This new lateral flow immunochromatographic test offers enhanced sensitivity through the detection of Trichomonas antigen as opposed to the traditional wet prep method, which relied on the labor intensive microscopic visualization of motile Trichomonas trophozoites. Because this new assay detects antigen as opposed to viable organism, specimen stability is also extended. When collected with a single eSwab™, specimens are stable for up to 24 hours at ambient temperature and 36 hours when refrigerated. Swabs collected for the wet prep method were only stable for 3-5 hours, so there is no longer a need for STAT delivery to the laboratory.
In anticipation of “Flu season”, it is valuable to revisit available testing methods for influenza and discuss when each test should be ordered. Though generally a self-limited infection for otherwise healthy individuals, influenza can be particularly severe for high-risk populations including infants, elderly, pregnant women, and immunocompromised hosts. Influenza incidence is largely seasonal with the majority of cases occurring between December and April of each year.