Improving serological test ordering patterns for the diagnosis of celiac disease through clinical laboratory audit of practice

BackgroundClinical Practice Guidelines (CPG) from both adult medicine and pediatrics recommend tTG to screen for celiac disease (CD).Design and methodsSerological test orders for celiac disease were evaluated against the guidelines. Ordering physicians were categorized as gastroenterologists, immunologists, pediatricians, other hospital physicians and non-hospital physicians. Interventions based on initial audit were implemented, including interacting with physicians, revising test menu and changing test ordering policy. After implementation of interventions, test orders were re-evaluated.ResultsAfter corrective interventions celiac panel (CP) orders were decreased from 48.4% to 3.6% in children, and from 72.3% to 28.1% in adults. Physicians ordered tTG alone for more than 90% of children. In adults the ordering of tTG alone was significantly increased from 7.2% to 61.3% (from 8.9% to 63.9% for gastroenterologists and from 8.1% to 44.4% for other physicians (p < 0.05)).ConclusionsThe audit reduced the CPG-practice gap that existed in the screening of CD.

► Clinical audit can successfully contribute to change in laboratory orders.
► Laboratory staff must be proactive in introducing best practice as defined by CPG.
► Celiac disease testing needs to be revised if gliadin tests are still offered.