Is it safe to have a laboratory test?

Authors: D. Joe Boone1
Author Affiliations: 1: Division of Laboratory Systems Centers for
Disease Control and Prevention 4770 Buford Highway (MS-G25) Atlanta GA 30341
USA

Source: Accreditation and Quality Assurance: Journal for Quality,
Comparability and Reliability in Chemical Measurement, Volume 10, Numbers
1-2)
Page Numbers: 5 - 9

Abstract: A recent US Institute of Medicine report indicated that up
to 98,000 deaths and more than 1 million injuries occur each year in the
United States due to medical errors. These include diagnostic errors, such
as an “error or delay in diagnosis, failure to employ indicated tests” and
the “use of outmoded tests.” Laboratory tests provide up to 80% of the
information used by physicians to make important medical decisions,
therefore it is important to determine how often laboratory testing mistakes
occur, whether they cause patient harm, where they are most likely to occur
in the testing process, and how to prevent them from occurring. A review of
the literature and a US Quality Institute Conference in 2003 indicates that
errors in laboratory medicine occur most often in the pre-analytical and
post-analytical steps in the testing process, but most of the quality
improvement efforts focus on improving the analytical process. Measures must
be developed and employed to reduce the potential for mistakes in laboratory
medicine, including better indicators for the quality of laboratory service.
Users of laboratory services must be linked with the laboratory’s
information system to assist them with decisions about test ordering,
patient preparation, and test interpretation. Quality assessment efforts
need to be expanded beyond external quality assessment programs to encompass
the detection of non-analytical mistakes and improving communication between
the users of and providers of laboratory services. The actual number of
mistakes in laboratory testing is not fully recognized, because no
widespread process is in place to either determine how often mistakes occur
or to systematically eliminate sources of error. We also tend to focus on
mistakes that result in adverse events, not the near misses that cause no
observable harm. The users of laboratory services must become aware of where
testing mistakes can occur and actively participate in designing processes
to prevent mistakes. Most importantly, healthcare institutions need to adopt
a culture of safety, which is implemented at all levels of the organization.
This includes establishing closer links between providers of laboratory
services and others in the healthcare delivery system. This was the theme of
a 2003 Quality Institute Conference aimed at “making the laboratory a key
partner in patient safety.” Plans to create a permanent public–private
partnership, called the Institute for Quality in Laboratory Medicine, whose
mission is to promote improvements in the use of laboratory tests and
laboratory services are underway.
Citation: D. Joe Boone . Is it safe to have a laboratory test?.
Accreditation and Quality Assurance: Journal for Quality, Comparability and
Reliability in Chemical Measurement, Volume 10, Numbers 1-2(December 2004),
pp. 5-9,
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