Do reflex comments on laboratory reports alter patient management?

Abstract

Introduction Laboratory comments appended on clinical biochemistry reports are common in the UK. Although popular with clinicians and the public, there is little evidence that these comments influence the clinical management of patients. Methods We provided reflex automated laboratory comments on all primary care lipid results including, if appropriate, recommendation of direct referral to the West Midlands Familial Hypercholesterolaemia service (WMFHS). Over a two-year period, the number GP referrals from the Wolverhampton City Clinical Commissioning Group (CCG) to the WMFHS were compared with four comparator CCGs of similar population size, who were not provided with reflex laboratory comments. Results Over the study period, the WMFHS received more referrals from Wolverhampton GPs (241) than any other comparator CCG (range 8–65) and greater than the combined referrals (172) from all four comparator CCGs. Conclusion Targeted reflex laboratory comments may influence the clinical management of patients and may have a role in the identification of individuals with familial hypercholesterolaemia.

Effect of automated feedback laboratory comments promoting good phlebotomy practice on the frequency of ethylenediaminetetraacetic acid (EDTA) contamination of serum samples

“…Interpretative comments are widely believed to add value to laboratory practice by improving patient safety, user satisfaction and outcomes. [15][16][17][18][19][20] They are appreciated by clinical colleagues and may be of educational value. 21,22 The provision of interpretative comments is considered an important element of the post-analytical phase and the International Standards Organization's guidance for medical laboratories (ISO 15189:2012) advises the provision of interpretative comments on results where applicable.…”

“…15,23 However, evidence for the efficacy of interpretative comments in achieving outcomes is limited and generally focuses on aiding result interpretation, facilitating clinical management decisions and modifying testrequesting behaviour. 16,[18][19][20]24,25 This study is the first, to our knowledge, reporting an association between implementation of educational laboratory comments and reduction in a pre-analytical error. No other factors that may have affected EDTA contamination, such as changes in phlebotomy devices, phlebotomy training, and sample handling and rejection practices, occurred during the study period.…”

“…and <0 20. mmol/L test results were released with the comment 'Possible potassium EDTA contamination, please send repeat specimen.…”