Optimization of protein electrophoresis test orders: results after the implementation of a protocol based on...

Serum protein electrophoresis is a valuable tool for diagnosing and monitoring monoclonal gammopathies, but its widespread use outside this context may be clinically unjustified. To promote more rational test ordering, a demand optimization protocol has been designed and implemented in the Valladolid Oeste Health Area (ASVAO), aligned with AEBM-ML and SEQC-ML recommendations.

A retrospective observational and interventional study was conducted. The protocol included automated request blocks for patients under 40, revision of analytical profiles, electronic alerts, and automatic inclusion based on specific biochemical alterations. The protocol was disseminated and training was provided to ordering physicians in both primary care and hospital settings. Structural, process, and activity indicators have been monitored from January 2023 to June 2025.

Orders in patients under 50 years decreased from 23.5 % in 2023 to 14.1 % in 2025. The proportion of orders for patients ≥50 years exceeded the target (>0.80) in 2025. Inappropriate analytical profiles have been eliminated, although the rate of orders without clinical or analytical justification remained elevated (0.53 in 2025). Test volume per inhabitant remained stable. Primary Care, Gastroenterology, Nephrology, and Pediatrics significantly reduced testing in younger patients, while Rheumatology increased it.

The protocol effectively improved test appropriateness, particularly regarding age targeting and the removal of automated orders. However, unjustified orders persist. Ongoing monitoring of indicators is recommended to consolidate improvements and address deviations.