AUDIT OF ADVANCED LABORATORY INVESTIGATIONS
AbstractBackground: Advanced laboratory investigations at reference laboratories play a key role in the diagnosis of the disease, but misuse of this precious and expensive tool may misguide the physician in patient management. This study was carried out as an audit of investigations performed at a reference laboratory, in order to assess their cost effectiveness, to identify various errors, the degree of correlation of requested tests with the clinical diagnosis and benefit to the patients. Method: A four phase audit of 337 laboratory investigation prescription was performed from April 2012 to March 2013 in the Medical Administration in collaboration with Department of Medical Laboratory and various Clinics at the King Salman Armed Forces Hospital in Northwestern Region - Kingdom of Saudi Arabia. All the information was recorded on a questionnaire Performa. Results: On data compilation and analysis it was found that 174(51.63%) test results were within normal reference range, while 163 (48.37%) test results were reported as positive. Also 218 (64.69%) investigations results correlated with clinical assessment by the physician, while 119 (35.31%) investigation results did not correlate with the clinical assessment by the physician. The expenses incurred Euro 12868 were spent on non-correlated tests while on correlated tests were Euro 31831. In terms of benefit to the patients 243 (82.09%) patients were reported by clinicians to have benefited from the reference laboratory tests, while 53 (17.91%) cases did not benefit from the reference laboratory tests as assessed by the clinicians and 41 (12.16%) cases in which even clinician did not respond regarding the benefit to the patients. Three categories of errors were identified (26.40%), i.e., at the level of clinicians (12.75%), at the level of hospital lab (5.04%) and at the level of reference lab (8.60%).Conclusion: Thorough clinical assessment and judicious utilization of available preliminary laboratory tests are the keys to precise diagnosis and are instrumental in reducing reliance on reference laboratory investigations.
Frank H. Wians, Jr., Clinical Laboratory Tests: Which, Why, and What Do The Results Mean? Lab Med 2009;40:105–13.
Gras JM, Philippe M. Application of Six Sigma concept in clinical laboratories: A review. ClinChem Lab Med 2007;45(6):789–796.
LambCR. Statistical briefing: Estimating the probability of disease. Vet RadiolUltrasound 2007;48:297–98.
Veltri RW, Chaudhari M, Miller MC, Poole EC, O'Dowd GJ, Partin AW. Comparison of logistic regression and neural net modeling for prediction of prostate cancer pathologic stage. ClinChem 2002;48(10):1828–34.
DART Trial Team, Mugyenyi P, Walker AS, Hakim J, Munderi P, Gibb DM, et al. Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trial. Lancet 2010;375(9709):123–31.
Petersen ML, van der Laan MJ, Napravnik S, Eron JJ, Moore RD, Deeks SG. Long-term consequences of the delay between virologic failure of highly active antiretroviral therapy and regimen modification. AIDS 2008;22(16):2097–106.
Liu Z, Abdullah A, Baskin L, Lewis G, Kelter G, Naugler C. An intervention to reduce laboratory utilization of referred-out tests. Lab Med 2012;43(5);3:164–7.
Kratz A, Laposata M. Enhanced clinical consulting – moving toward the core competencies of laboratory professionals. ClinChimActa 2002;319(2):117–25.
Price CP, Christenson RH. Teaching evidence-based laboratory medicine: a cultural experience. In: Price CP, Christenson RH editors. Evidence-based laboratory medicine. From principles to outcomes, AACC Press, Washington; 2003. pp. 225–45.
Baldwin DM, Quintela J, Duclos C, Staton EW, Pace WD. Patient preferences for notification of normal laboratory test results: a report from the ASIPS Collaborative. BMC Fam Pract 2005;6(1):11.
Poon EG, Gandhi TK, Sequist TD, Murff HJ, Karson AS, Bates DW. “I wish I had seen this result earlier!”: dissatisfaction with the test result management systems in primary care. Arch Intern Med 2004;164(20):2223–8.
Young DS, Sachais BS, Jefferies LC. Laboratory costs in the context of disease. ClinChem 2000;46(7):967–75.
Wians FH Jr. Luminaries in laboratory medicine: Otto Folin Lab Med 2009;40:1–2.
Wians FH Jr, Baskin LB. Chapter 2: The Use of Clinical Laboratory Tests in Diagnostic Decision-Making. In: Handbook of Clinical Pathology, ASCP Press: Chicago; 2000:9–24.
Kengasong N. Strengthening laboratory services and systems in resource-poor countries. Am J ClinPathol 2009;131(6):774.
Pathology Review Advisory Group. Report of the Review of NHS Pathology Services in England. 2006. [Internet] [Cited 2010 Jan 28]Available from:http://www.pathologists.org.uk/publications-page/Carter%20Report-The%20Report.pdf
Phillips AN, Pillay D ,Miners AH, Bennett DE, Gilks CF, Lundgren JD. Outcomes from monitoring of patients on antiretroviral therapy in resource-limited settings with viral load, CD4 cell count, or clinical observation alone: a computer simulation model. Lancet 2008;371(9622):1443–51.
Mee P, Fielding KL, Charalambous S, Churchyard GJ, Grant AD. Evaluation of the WHO criteria for antiretroviral treatment failure among adults in South Africa. AIDS 2008;22(15):1971–7.
Plebani M. Exploring the iceberg of errors in laboratory medicine. ClinChimActa 2009;404(1):16–23.
Plebani M. Errors in clinical laboratories or errors in laboratory medicine. ClinChem Lab Med 2006;44(6):750–9.
Kalra J. Medical errors: impact on clinical laboratories and other critical areas. ClinBiochem 2004;37(12):1052–62