P09 Audit of anti-nuclear antibody testing in East Kent and the British Society for Rheumatology Choosing Wisely recommendations

Abstract

Background The British Society for Rheumatology has recently issued Choosing Wisely guidance on ANA testing, to avoid unnecessary testing and inappropriate use of resources. Currently there are no local guidelines on ANA testing. The aim of this audit was to use the BSR guidance as best practice to assess current local testing and then develop guidelines. The standards assessed were as follows: testing ANA should be reserved for patients suspected to have a diagnosis of a connective tissue disease, e.g. lupus. Testing ANA should be avoided in the investigation of widespread pain or fatigue alone. Repeat testing is not normally indicated unless the clinical picture changes significantly. Methods Retrospective data collection of ANA requests at East Kent Hospitals University & Foundation Trust was extracted from the pathology IT system (Apex) from January to March 2019. The clinical indications entered for electronic requesting were recorded. All ANA requests were recorded as ‘appropriate’, ‘inappropriate’ or having ‘insufficient documentation’. A request was considered appropriate if it documented one of the following indications/suspected diagnoses: inflammatory arthritis, connective tissue features - Raynaud’s, vasculitis/photosensitive rash, scleroderma, clinical myositis, autoimmune haemolytic anaemias, cytopenia, Suspected autoimmune liver disease, pleurisy, pulmonary fibrosis, pericarditis, serositis, autoimmune renal disease, autoimmune neurologic disease, BILAG registered patients, patients on/requiring biologics. All other requests which did not meet these standards were considered inappropriate. Results There were 1,517 requests made in 3 months; 180 requests (11.86%) were positive and 1,337 (88.14%) were negative. 61% of ANA requests were from outpatients, 25% were inpatient requests and 14% were requests from GPs. Outpatients requests: neurology, rheumatology, gastroenterology, respiratory and renal medicine (in order of frequency). Only 17% of requests met the set standards; 41% were inappropriate requests and 42% were requests with insufficient details. Conclusion ANA testing is relatively expensive compared to other routine screening tests. The assay is time consuming and labour-intensive, and due to the volume of requests made, 2 batches are tested daily in East Kent. With only 17% of the 1,517 tests meeting the standards, this suggests the majority were inappropriately requested. There were >15,000 requests from East Kent and nearby trusts from April 2018 to December 2018. At £2.50 per test, adhering to guidelines could save potentially £12,000 per year. Local guidelines have now been devised based on the Choosing Wisely standards, indications & suspected diagnoses documented. ANA testing will be re-audited in 6 months. Disclosures S. Rasool None. K. Beharry None. A. Afifi None. F. Shahzad None. R. mahadi None. D. De Lord None.