Healthcare needs to be safe, effective, efficient, timely, patient-centered and equitable. Each of these attributes is one of the Institute of Medicine’s (IOM) Quality Aims, and each describes one component of the framework to examine and improve the laboratory testing process.
Safe healthcare is defined as “avoiding harm to patients from the care that is intended to help them”.1 Before the laboratory testing process can be improved, we must define harm to patients if the laboratory testing process is executed improperly. Misdiagnosis, delayed diagnosis or inappropriate treatment are several examples of harm or adverse events that may occur if laboratory testing processes are improperly performed.
More errors are identified in the pre-analytic and post-analytic phases of laboratory testing and the first (selecting the correct test to perform) and the last (accurately interpreting test results) steps are the most vulnerable for errors2. Failing to order the correct laboratory test for a patient’s clinical condition or failing to interpret laboratory test results appropriately can result in either a false positive (identifying a condition that is not present) or a false negative (failing to identify a condition that is present).
The greatest opportunity to improve the safety of medical laboratory testing is to work with clinicians to improve the test selection process and the interpretation of laboratory test results. This requires employing concepts and methods of several other IOM Quality Aims, primarily examining the effectiveness of the laboratory testing process. It also requires, as a first step, gathering data to identify the frequency of errors in these two steps for patients who use the laboratory’s services.
Before we leave the subject of safety and the laboratory, it is important to distinguish ‘patient safety’ from ‘laboratory safety’. ‘Patient safety’ focuses on reducing errors that occur in the laboratory testing process. Its purpose is to improve the care that patients receive as a result of using the laboratory test information. ‘Laboratory safety’ ensures Medical Laboratory professionals are safe while analyzing specimens. It requires the use of personal protective equipment and specific procedures to ensure that they are not harmed as they are performing their duties. Both are important, however they are not identical nor interchangeable. One focuses on the process of care (laboratory testing process) for the patient (patient safety) and the other on the Medical Laboratory professional (laboratory safety).
Committee on Quality of Health Care in America. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academy Press; 2001.
Plebani M. Exploring the iceberg of errors in laboratory medicine. Clin Chim Acta 2009; 45: 712-719