As lab medicine professionals, we are fully aware of the unquestionable importance of our profession. In the UK alone, every citizen has an average of 14 tests per year performed by a laboratory medicine specialist. Department heads increasingly rate quality care and value-for-money as key priorities, so a recognition of the value of lab medicine is of crucial importance, especially when it comes to ensuring appropriate allocation of resources. But is laboratory medicine falling at the last hurdle when it comes to providing improved benefits for patients? The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) task force on the impact of laboratory medicine on clinical management and outcomes was set up in 2012 to settle this very problem, to evaluate the evidence supporting the impact of laboratory medicine, and to promote contributions from the field.
No doubt you will have heard the frequently cited claim that laboratory medicine plays a role in 70 percent of clinical decisions. That assertion sounds plausible, but the data on which the claim is based represent unpublished studies and anecdotal observations, and cannot be objectively veriﬁed at this stage. So where did it come from?
The earliest reference to the claim can be found in a 1996 paper from the Mayo Clinic in the US, where the author stated, “We know that, although the laboratory represents a small percentage of medical center costs, it leverages 60–70 percent of all critical decisions, e.g. admission, discharge and therapy “. But even that paper failed to provide evidence for its statement. In the 19 years since the paper was published, in true Chinese whispers style, the statement has been taken and extrapolated upon, from 70 percent of critical medical decisions to 70 percent of all medical decisions.
The model proposed by the IFCC task force for measuring the net clinical value of a test involves balancing the benefits that a test delivers against any harm it may cause. For the model to work and to increase the value of a test, it’s important to first accept that testing can sometimes cause harm. In general, that harm stems from one of five possible sources, originally described by Epner et al.:
- An inappropriate test may be ordered
- The appropriate test may not be ordered
- The appropriate test result may not be used properly
- The appropriate test result may be delayed or missed
- The appropriate test result may be wrong or inaccurate.
An incorrect result, the area that receives most of our attention, is also the area with the lowest cause of diagnostic error – primarily because we in the lab have spent so much time focusing on this aspect. Now’s the time we need to get serious about some of the other factors.
Read the full article by clicking on the title above.