b'How is syndromic molecular testing improving patientBut the potential for over-testing is not unique to care versus more traditional approaches? syndromic testing.Syndromic testing allows the laboratory to detect a number ofIts pretty much an issue with any laboratory test and why different pathogens all at the same time, and it allows you to dostewardship is so important. Clinicians need to order the right that in a very fast waytypically within an hour or so. tests at the right time and for the right patients only.Lets say, for example, the patient presents with respiratoryLeaving COVID-19 aside for the moment, lets say if you have symptoms. A variety of organisms can cause that infection.a patient that doesnt have any respiratory symptoms. If you Syndromic molecular testing allows a provider not to have to thinkchoose to test them with a respiratory panel anyway and find about each potential pathogen that a patient may be infectedtheyre positive for rhinovirus/enterovirus, the clinician then has to with. The hope is that they can react to it quickly, whether it bedecide, do I need to isolate this patient? Whats the cost of care withholding or initiating antimicrobials when necessary. related to that?These benefits have the potential to encourageFinding results like this from inappropriate testing can distract overuse. How do you address that? clinicians from further pursuing an actual diagnosis. They might Because these tests are so readily available and so easy to test,focus on that rhinovirus and enterovirus result while there is there is the risk of over-testing, particularly in patients that maysomething else wrong with that patient. The test can potentially not fit the criteria for that test. point clinicians in the wrong direction and prevent them from exploring the real reason behind the patients health problems.Unfortunately, over-testing dilutes the positive effect that these tests can have. When youre doing studies and pulling results ofHow can laboratory stewardship optimize testing and all the patients youre testing, if theres a subset of patients whoimprove care?shouldnt have been tested, it affects results. There are things we can do to prevent overuse of syndromic Its also important to note that some insurance companies havepanels, such as placing automatic testing restrictions. very defined criteria as to the patient population for these tests,For example, if you have a patient who is tested using a and who theyll reimburse for. syndromic respiratory panel, the likelihood of the same patient needing to be tested again within 7, 10, or 14 days is very low. If youre comparing traditional culture to a multiplex syndromicRepeat testing hasnt been found to be helpful. Other options panel, of course the cost of the test would be a lot more thanwould be to require an infectious disease consult prior to it would be for just a culture. That costs the healthcare system,approving specific test orders.which may then charge patients for a portion of that test thatEducation is always a huge piece of this. Its communicatingwith providers so that they understand what the test actually is, theyre not being reimbursed for. Over-testing raises costs all around. how it works, and the answers it can potentially provide. This is where clinical microbiologists are important, and why we work so closely with physicians, antimicrobial stewardship teams, and infectious diseases teams. We are available for consults as part of clinical services and can guide clinicians on the utility of a test.It shouldnt be assumed or expected that clinicians are going Clinicians need to orderto understand the ins and outs of every single laboratory test.Thats why offering continuing education and consult services the right tests that explain specifically what test are for, the potential limitations, and how to interpret the results can help guide the management at the right time of patients.and for the right patients18 Molecular testing thermofisher.com/infectiousdisease Contents'