PROVIDING TIMELY PATIENT-CENTERED MOLECULAR DIAGNOSTIC TESTING FOR PATIENTS WITH ACUTE MYELOID LEUKEMIA: A QUALITY IMPROVEMENT STUDY

Introduction

At many centers, molecular diagnostic (MD) testing for Acute Myeloid Leukemia (AML) struggles to meet turn-around-time (TAT) required for therapeutic decision-making. At our tertiary referral centre, TAT for MD (karyotyping and next-generation sequencing [NGS]) exceeded 4 weeks, resulting in a 'quality gap' in our care pathway for AML. The goal of our study was to improve TAT for MD to optimize care for patients with AML/MDS.

Methods

A multidisciplinary team (hematologists, laboratory scientists, and hematopathologists) defined target TATs for each MD test based on guidelines and available therapies. TAT was evaluated from time of bone marrow to MD reporting. Retrospective review from 2021-2022 was performed to establish baseline time points to compare to post-intervention TATs. Root cause analysis was performed through stakeholder interviews to identify areas contributing to delays in TAT. The primary outcome was the ability to meet target TAT for MD.

Results

Baseline TAT for cytogenetics and NGS varied widely and exceeded targets (Figure 1). Root cause analysis identified lack standardized ordering and testing for patients with AML due to inconsistent decision-maker awareness. Laboratory factors included batching and lack prioritization of AML samples. Interventions included a standardized AML testing algorithm triggered reflexively by flow cytometry at the time diagnosis. Impact of laboratory triggered algorithm for AML testing is shown in Figure 1.

Conclusions

Shared decision-making between hematologists and laboratory practitioners to develop an algorithm for reflex testing and treatment of AML improved TAT. Further improvements are underway to acheive targets, and lessons will be used to inform care pathways for AML/MDS.