Effective Tuesday, July 24, 2012, there will be changes in how frequently certain laboratory tests can be performed.  These include erythrocyte sedimentation rate (ESR), protein electrophoresis tests, and the automated differential portion of the complete blood count.  An analysis of test ordering patterns reveals significant over-utilization of testing which can cause iatrogenic blood loss, excess labor, and time spent reviewing testing.  For example, ESR changes slowly over the course of days.  Daily measurement has not been shown to be clinically useful in monitoring processes such as infection and, in fact, may be clinically misleading.

The processing instructions for these tests in Epic will indicate the maximum frequency.  Orders more frequent than the allowed frequency will be automatically cancelled.

The specific changes are as follows:

Epic	Epic #	Maximum frequency
ERYTHROCYTE SEDIMENTATION RATE	LAB1035	Once every 48 hours
SERUM PROTEIN ELECTROPHORESIS	LAB953	Once / 1 week
SERUM IMMUNOFIXATION ELECTROPHORESIS	LAB156	Once / 1 week
URINE PROTEIN ELECTROPHORESIS	Order panel O51238	Once / 1 week
URINE IMMUNOFIXATION ELECTROPHORESIS	Order panel O51241	Once / 1 week
KAPPA-LAMBDA QUANT FREE LIGHT CHAIN RATIO, BLOOD	LAB3466	Once every 48 hours
KAPPA-LAMBDA LIGHT CHAIN URINE	LAB7454	Once / 1 week
AUTOMATED DIFFERENTIAL*	Part of order panel 263314	Once every 24 hours

*This does not impact the ability to get the complete blood count, only the differential portion.

Questions should be directed to Matthew Krasowski, MD, PhD, medical director of the Clinical Chemistry Laboratory (384-9380, matthew-krasowski@uiowa.edu).