Case Study Review: Clinical Decision Making for Multiple Myeloma Lab Testing
Introduction
Professor Guy Pratt explains
In this video, Professor Guy Pratt discusses the ‘GP Myeloma Diagnostic Tool’ endorsed in the recent Myeloma UK working group guideline paper by Drayson M et al. (Br J Haematol 2024; In Press). This tool serves as a valuable guide for both primary care practitioners and clinical laboratories suggesting when and how urgently to refer myeloma patients.
You can access this tool by visiting the following web address: https://academy.myeloma.org.uk/resources/gp-myeloma-diagnostic-tool.
Speaker
Featured in this video
Professor Guy Pratt
Professor of Hematology at the University of Birmingham and Deputy Director of the Cancer Research UK Clinical Trials Unit
Key Takeaways
Clinical Decision Support Tool Case Studies
Hampshire Hospitals, UK
Accelerated urgent patient reviews and eliminated 10% of avoidable hematology referrals and queries.
The immunology laboratory at Hampshire Hospitals introduced a clinical decision support system with the goal to enhance the diagnostic investigation process for Multiple Myeloma at their site. Their primary focus was to improve compliance with test guidelines and reduce inappropriate patient referrals to the hematology department1,2.
Following the implementation of the clinical decision support system, Hampshire Hospitals experienced a number of benefits, leading to them being awarded the prestigious UNIVANTS Healthcare prize for ‘excellence in patient care’.
- Accelerated urgent patient reviews
- Reduced inappropriate hematology referrals
- Increased guideline-compliance testing
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Hospital Universitario Donostia
Conducted a validation of the SPE + sFLC testing panel for Multiple Myeloma diagnosis investigations using a cohort of 261 patients1. The patients had presented either with clinical symptoms or analytical indicators suggestive of a monoclonal gammopathy. 28 of these patients were later confirmed to have a monoclonal gammopathy.
Hospital Universitario Donostia concluded that implementing this testing panel provides a laboratory staff saving of 15.6 hours per month by avoiding unnecessary immunofixation test orders.
Accurate identification of monoclonal gammopathy patients
Saving in laboratory time by reducing unnecessary and time-consuming test orders.
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St. Elizabeth Healthcare, US
Estimated that time to diagnosis would decrease by more than 100 days.
To enhance guideline compliance within their organization, St. Elizabeth Healthcare introduced a "Myeloma Screening Panel”, which combines sFLC and SPE tests into a single order, with the option for immunofixation electrophoresis if necessary3,4. The primary purpose of this panel was to offer guidance to healthcare practitioners, assisting them in making optimal, guideline-compliant test selections.
"As laboratorians, we are in a position of privilege, that is we have line of sight to the ordering behavior's to all our clinicians in our system, […] we have a responsibility to leverage our unique position, to drive conversations about the patterns we observe, and to nudge healthcare provider to optimal test choices." - Dr Jeremy Hart, Medical Director of Clinical Laboratories at St. Elizabeth Healthcare System.
Following implementation, St. Elizabeth Healthcare received more guideline compliant test requests and calculated an improvement of more than 100 days in time to diagnosis for Multiple Myeloma patients.
- Improve time to diagnosis
- Increased guideline compliant testing
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Massachusetts General Hospital, US
Identified an additional 17% of new monoclonal gammopathy patients.
To improve guideline compliance for Multiple Myeloma investigations, Massachusetts General Hospital designed and deployed a targeted clinical decision support alert to educate and prompt providers within their organization to order a sFLC test when requesting SPE5.
The implementation of this alert led to a significant improvement in test requesting practice, especially amongst primary care practitioners. During the implementation process, 452 (17%) new monoclonal gammopathy patients were identified, where sFLC testing gave the only evidence of a monoclonal-protein. These patients may have been missed before Massachusetts General Hospital implemented these targeted clinical decision support alerts.
- Identified an additional 17% of new MG patients
- Increased guideline compliant testing particularly in primary care
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Clinical decision support tools and testing panels can drive improvements in Multiple Myeloma investigations
Testing panels consist of a predetermined set of medical tests strategically employed together for the purpose of disease diagnosis. Leveraging laboratory information systems, clinical decision support tools provide evidence-based guidance regarding the selection of tests, interpretation of test results, and recommendations for subsequent follow-up.
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References
- Scott K. Clinical Laboratory News. 2022; 8
- Myeloma-UK. Improving patient pathways for myeloma. 2022;
- Hart J. Laboratory Screening for Multiple Myeloma: A Nudge in the Direction of Guideline Compliance. Labroots webinar 2021;
- Hart J & Flora D. Guideline Compliance in Multiple Myeloma Testing: An Audit of Orders by Specialty. Presented at AACC 2020; B-223
- Pearson DS, et al. Use of Clinical Decision Support to Improve the Laboratory Evaluation of Monoclonal Gammopathies. Am J Clin Pathol 2023; 159:192-204
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