Clinical Laboratories Reflexive Ordering
Clinical Laboratories Reflexive Ordering
The UCSF Medical Board recognizes that in some instances it is medically appropriate to perform reflex testing based on an initial laboratory result and in other instances reflex testing should be at the discretion of the ordering practitioner. In accordance with the UCSF Clinical Laboratory OIG Compliance Plan we approve the following reflex testing activity as proposed by the Laboratory Director. (Approved by UCSF EMB 12/18/07)
| TEST ORDER | REFLEX ACTION | OPTION |
|---|---|---|
|
BLOOD BANK |
||
| Antibody Screen | If positive, testing initiated as required to identify the antibody. | None, always reflexed |
| Direct Coombs Test | If positive, initiates testing to determine if reactivity due to IgG or Complement on Red cells | None, always reflexed |
|
CHEMISTRY |
||
| Hemoglobinopathy evaluation | If variant hemoglobin is detected by HPLC , hemoglobin electrophoresis is performed to characterize and classify the variant. | None, always reflexed |
|
CYTOGENETICS |
||
| Chromosome analysis | If an abnormality is detected the Director will determine the
appropriate additional studies to be performed to characterize the
abnormality |
Lab may be asked to omit or inform the clinician prior to
performing reflex testing. |
|
IMMUNOLOGY |
||
| Hep B Surface Ag |
Confirmatory test is run all all
positives at a separate charge |
None, always reflexed |
| HIV Antibody | If positive, confirmatory western blot is performed | None, always reflexed |
| HTLV-I Ab Screen | A specimen which is positive by EIA will be referred automatically to the State Viral Diseases Laboratory for confirmatory testing, each step of which will incur additional charges | None, always reflexed |
| RPR (Routine or Prenatal) | If positive, titer is performed but not billed. If positive TP-AB is performed to confirm and billed. | Requisition allows RPR to be ordered w/out reflex TP-AB |
|
MICROBIOLOGY |
||
| Bacterial Culture | If bacteria are present they are identified and susceptibility testing is performed as appropriate. | Requisition allows for omission of full ID and susceptibility testing |
| Cryptococcal Antigen | If positive, specimen is titered at a separate charge. | None, always reflexed |
| First positive sputum smear for Acid-Fast-Bacilli (AFB) | Automatic reflex to State laboratory for Molecular probe testing for M. tuberculosis. | None, always reflexed |
|
NCPL |
||
| HIV, Rapid Antibody Screen | If positive a confirmatory Western Blot will be performed | None, always reflexed |
|
VIROLOGY |
||
| Clostridium difficile Antigen | Cell culture and neutralization for toxin will be performed if antigen is positive and billed separately. | None, always reflexed |
| Respiratory Virus DFA | If positive polyvalent screening stain, further testing done with specific stains for individual viruses | Requisition allows user to select panel or individual viral DFA's |