To identify barriers to comprehensive testing and resulting in paraneoplastic neurological disorders (PND).

A diagnosis of PND depends on test results (PND panel). Delays in test results may have a negative impact on both patient care and other quality measures. Our institution recently changed PND panel ordering from a manual process to an order set using the electronic medical record (EMR). Quality measures of interest to us include: 1) receipt of PND panel results once ordered; and 2) obtaining the most comprehensive PND results available.

Retrospective comparison of successful PND panel collection rates and comprehensive results reporting for two periods: Group A) six months before and Group B) six months after creation of an EMR specified order.

After the initial PND panel request, 17/41 (42%) of orders placed were resulted for Group A and 26/41 (63%) for Group B. Of the 17 PND panel test results in Group A, only 5 represented the most comprehensive results available. Of the 26 results in Group B, all were comprehensive.

Initiation of a PND panel specified order set in the EMR resulted in both improved resulting rates and comprehensiveness of results.  Still, a high rate of failed resulting on first order placement (37%) remained.  These failures may have contributed both to patient care and the costs associated with delays in results reporting.  The reasons underlying this are under investigation with a goal of obtaining 100% success in results reporting upon first order placement. This quality improvement project represents a detailed step-by-step analysis for obtaining optimal results from a costly test with a long turnaround time and may provide insight into how this process might be applied at other institutions.