January 14, 2009

To:Chiefs of Service, Attending Physicians, Housestaff, Nurses, and Other Concerned Personnel

From:Eberhard Fiebig, MD, Director, Clinical Laboratory

Mary N. Clancy, Laboratory Manager

Jeff Critchfield, MD, Chief of Medical Staff

John Luce, MD, Chief Medical Officer

Re:Restrictions in Send-out Testing (Tests Performed by Outside Laboratories)

______

As of 1/27/09, the Clinical Laboratory will restrict ordering of the tests listed in the table below to specialty locations and authorized providers. This is to achieve cost savings for expensive tests for which SFGH receives little or no reimbursement, and to improve medical utility, as the restricted tests have very specific indications and are most useful in a specific clinical context.

What will happen?

  1. Restrictions in Ordering of Listed Tests
  2. The ordering status of restricted tests (see table, page 2) will initially be shown as “PENDING” in the LCR – subsequently the status will change to “CANCELED” with the comment “Restricted test - see LCR test name icon for details.” Clicking on the icon will show a statement that the test is restricted and a link to this memo.
  3. Specimens will be held for at least as long as they are stable for testing (see table).
  1. Conditions on Which Restricted Send-out Tests will be Performed
  2. Tests are requested from a location that is approved for this test (see table), provided the ordering location is clearly marked on the requisition;

OR

  • Test requests are approved by an authorized provider (see table). For this, an authorized provider must submit his or her approval up to one month before the specimen is received in the laboratory, or within 4 days after receipt (due to limited sample stability). Please note that the name of the authorized provider on the requisition is not sufficient; explicit approval of the request by an authorized provider is required.
  1. How to obtain Approval for Restricted Send-out Tests
  2. Contact one of the MDs authorized to approve the request (see table) – preferably before the request is sent to the laboratory and via the eReferral system.
  3. Authorized providers must indicate approval via the eReferral system or by contacting Dr. Fiebig or his designee in the Clinical Laboratory.

Test Name / Specimen Stability / Approved Location / Utility / Authorized Providers (MDs)
Bile Acids, Fractionated / 7 days / N/A / Intrahepatic Cholestasis of Pregnancy / Juan Vargas, Beth Harleman, Marya Zlatnik, Rebecca Jackson (Obstetrics/Gynecology)
Cancer Ag-GI
(CA 19-9) / 4 days / WD 86-ONC / Monitoring of GI Cancers / Judy Luce (Oncology)
Cytogenetics –
Subtelomeric Probes / N/A – add/on test / N/A / Submicroscopic Chromosome Analysis / Susan Sniderman (Pediatrics)
H. Pylori Ag (Stool) / 4 days / WD 3D-GI / Effect of H. Pylori Treatment / Hal Yee (GI-Medicine)
Hemochromatosis Mutation by PCR / 7 days / N/A / Genetic Risk of Iron Overload in Whites / Brad Lewis (Hematology),
Hal Yee (GI-Medicine)
Homocysteine / 7 days / N/A / Arterial Thrombotic Risk Assessment / Brad Lewis (Hematology)
JAK2 Gene Mutation / 4 days / N/A / DDX of P. Vera and MyeloproliferativeDisorders
JC Virus by PCR / 7 days / N/A / Diagnosis of PML / Cheryl Jay, Richard Price, Serena Spudich (Neurology)
Keppra (Levetiracetam) / 7 days / N/A / Drug Level, Antiepileptic / Paul Garcia, Cheryl Jay, Richard Price (Neurology)
PTH related Peptide / 7 days / DDX Hyperparathyroidism / Elizabeth (Lisa) Murphy (Endocrinology)
Thyroglobulin / 7 days / WD 92 Endo / Thyroid Cancer Monitoring
Vitamin D
1,25 Dihydroxy / 7 days / Hypercalcemia, Renal Failure w/u

For any questions or comments regarding this memo, contact Dr. Fiebig at 206-8588 or via email: .

Thank you for your understanding and cooperation.