Module 5

Postanalytical Phase of Laboratory

Testing

Once an accurate test result is obtained the lab must

O Report the result in a timely manner by:O Using an electronic process allowing for

acceptable results to be transmitted electronically via an ‘interface’ between the analyzer and lab information system(LIS) and then via another ‘interface’ between the LIS and the electronic medical record (EMR) or….

O Transcribing accurately the results to a paper or written medical record

O The vast majority of results are transmitted by the first mechanism

Photo by Theresa Kristopaitis, MD

Case Scenario 1O A 68-year old woman with atrial

fibrillation chronically anticoagulated with warfarin presents for her monthly INR blood draw. She relates to the nurses that her husband died unexpectedly 3 weeks ago and she has had a very poor appetite since.

Photo by Theresa Kristopaitis, MD

Case Scenario 1Result

Component Value Flag Reference Range

PROTHROMBIN TIME 68.6 H 9.2 - 11.8 SEC INR RATIO 5.3 H

Comment: SUGGESTED THERAPEUTIC RANGE FOR CONTROL OF ORAL ANTICOAGULANT THERAPYINR 2.0-3.0 FOR DVT/PE, TISSUE VALVE, ATRIAL FIB, MI-STROKE PREVENTINR 2.5-3.5 FOR MECHANICAL VALVE

Case Scenario 1Per the laboratory guidelines, the INR result is considered a “critical result”. What is the next appropriate step taken by the laboratory technologist?

A. Call the patient with the abnormal test result B. Communicate the INR result directly to the ordering physician or their designate C. Notify the coagulation laboratory director of the test result D. Order a STAT re-draw of the patient sample and notify the patientE. Rush the written result report into the medical record

“Critical Results”O “Critical results” of tests fall significantly outside

the normal range, may indicate a life threatening situation, and may require immediate clinical actionO Values are decided upon in collaboration

with institution laboratory directors and physician leadership

O The objective is to provide the responsible licensed caregiver with these results within an established time frame so that the patient can be promptly treated

O The reporting of critical results in a timely basis is a 2013 JCAHO National Hospital Patient Safety Goal

“Critical Results”O Current regulations require that the

person receiving the report of the critical result be asked to read back the results to the lab staff member to ensure correct information was communicatedO This must be documented in the

medical record

Photo Theresa Kristopaitis, MD

Other Examples of Clinical Laboratory Critical Results

It Starts and Ends with the Patient

ORemember that the laboratory testing process begins and ends with patient care

OAll laboratory tests MUST be interpreted in light of the clinical situationO Although lab testing may yield

unexpected results that are critical in guiding further patient evaluation and management, clinicians must be vigilant for the possibility of spurious results from improper specimen collection, mislabeled specimens, clerical errors and other preanalytic, analytic and postanalytic ‘misadventures.’

Laboratory Staff are Members of the Healthcare

Team! O Clinicians should ALWAYS feel free to

contact lab directors and/or clinical laboratory staff with questions about any lab test:O Interpretation of resultsO Assurance of quality of a testO Discussion of potential sources of error or

variables to be considered in test interpretation

O Determination of need for a specialized test

O Proceed to Module 6 “Normal Values”:How are Normal Reference Ranges Established?