To study ordering practices in regards to autoantibody testing at a county hospital, determine the rate of a meaningful result, and to develop strategies to improve testing practices. 

The last decade has seen increasing discovery of autoantibodies directed against nervous system antigens. These novel disorders have dramatic phenotypes, and often have a favorable response to immunotherapy. Testing for antibody panels is now widely available, but carries significant costs and results often take weeks to return.  

A quality improvement project involving neurology and pathology was initiated to determine the practice patterns for autoantibody testing at Parkland Memorial Hospital (PMH). Following review, an intervention to mitigate overutilization was implemented. 

The results of all autoantibody panels submitted to referral labs for 2017 were reviewed. Records of all patients with a positive antibody result were reviewed to determine if available information was consistent with a well-described autoimmune disorder. 

Once these retrospective results were obtained, an intervention was initiated, in which the autoimmune neurology division reviewed all antibody testing requests and would communicate the likelihood of a meaningful result to the ordering physicians.   

For the year 2017, 196 samples were submitted for 151 patients at PMH. An antibody was detected in 36 patients. Review of available patient data found that 6 of 34 patients had a presentation consistent with an autoimmune disorder (17% of positives, 4% of total tests). 

To determine false-negative rates, the remaining 117 patients are being reviewed. 

In September 2018, nine tests were ordered and reviewed by the autoimmune neurology division. In discussion with ordering team, three tests were deferred (33% of total). 

The detection of meaningful autoantibodies was relatively low at PMH, and some ordering practices lead to over-utilization of antibody panels. Feedback from autoimmune neurologists may improve the rate of meaningful results at PMH.