What is an error in laboratory testing ?  Webster defines Error as “an act or condition of ignorant or imprudent deviation from a code of behavior”.1  A diagnostic error is defined as “the failure to (a) establish an  accurate and timely explanation of the patient’s health  problem(s) or (b) communicate that explanation to the patient”.An error in laboratory testing is any deviation from the steps in the process beginning with ordering the correct laboratory test to how the laboratory test information is used after it is sent to the clinician.    As laboratorians, we are meticulous from start to finish when we are performing laboratory test analyses–ensuring the specimen is collected appropriately from the correct patient, validating the accuracy of the analytical methods and providing test results in a timely manner.   Although it is understood among laboratorians that errors do occur at various stages of the laboratory testing process, one area that would benefit more of our attention is identifying those laboratory tests that are ordered inappropriately and assisting clinicians and others on the health care team with test interpretation.

Laboratory professionals are one member of the healthcare team, who work collaboratively to diagnose, treat and improve the life of each patient.   The healthcare team is made of individuals tailored to providing care that is specific to the needs of each individual patient.   The team may consist of physicians, physician’s assistants,  nurses, respiratory therapists, dieticians, physical therapists, pharmacists, as well as medical laboratory professionals;  all experts in their given fields.

As experts in laboratory testing, members of the healthcare team and models for our Code of Ethics3 , we are obligated to inform the rest of the team when errors may have occurred that might affect patient care–their diagnosis, treatment or health status.  Most likely you have answered questions such as these:    A pharmacist on your team, asks about a trough Vancomycin that was just as high as the peak?;   A nurse asks “What does that mean?” after you telephone with a critical hemoglobin result;    The Infection Control nurse asks for additional information about less common organisms identified in patient cultures;  A nurse calls to request  a potassium test to be added on to  a patient’s EDTA specimen.   The information you shared improved the care that those patients received and may have prevented a diagnostic error.

Medical laboratory professionals were identified as “critical to diagnosis” in the report Improving Diagnosis in Health Care4, the latest report to identify and describe methods to improve our healthcare delivery system.   Our efforts are critical in terms of the laboratory test information we provide, however the answers to questions we routinely provide demonstrate that we play a vital role on the health care team–one that we need to emphasize.  We need to expand our role on the healthcare team, first by acknowledging to ourselves and then others that providing answers to team members’ questions is valued and improves patient care.   Consider tracking the types of questions that your laboratory receives and then answers as one of the first steps to create systems to communicate and provide that information to members of the health care team.  Efforts such as these create the foundation for improving patient care and reducing errors.

References

  1. Merriam-Webster Dictionary. Error. https://www.merriam-webster.com/dictionary/error:  Accessed January 10, 2018.
  2. National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC:  The National Academies Press. p.4
  3. American Society for Clinical Laboratory Science. Code of Ethics.  http://www.ascls.org/about-us/code-of-ethics:  Accessed January 10, 2018.
  4. National Academies of Sciences, Engineering, and Medicine. 2015.  Improving Diagnosis in Health Care. Washington, DC:  The National Academies Press. p.8

About The Author

Catherine Otto is Chair of the American Society for Clinical Laboratory Science (ASCLS) Patient Safety Committee. She has taught hematology, immunology and laboratory management in Medical Laboratory Science programs and has delivered over 50 presentations on patient safety and quality improvement at state, regional, national and international meetings. She currently is Associate Professor in the Department of Clinical Laboratory and Medical Imaging Sciences at Rutgers University in Newark, New Jersey. __________________________________________________________________________________________ Karen Williams is a member of the ASCLS Patient Safety Committee. She is a 2016 graduate of ASCLS Leadership Academy and currently serves as President of the Louisiana Society (LSCLS). She works full-time at University Health Conway in Monroe, Louisiana as their Clinical Laboratory’s Quality Coordinator, part-time as a second shift generalist at St. Francis Medical Center in Monroe and she is an adjunct-faculty member at the University of Louisiana at Monroe.