Historically, the laboratory industry has focused its quality improvement efforts within the boundaries of the laboratory. We have been lab-centric in this respect and have not focused on collaboration with other members of the health care team or patient outcomes.
The laboratory has been very good at detecting and eliminating errors in the analytical phase. Less focus has been placed on identifying and remedying errors outside of the analytical phase, particularly those that occur outside the boundaries of the lab (pre-pre and post-post-analytical).
In order for the laboratory to have a positive impact on diagnostic errors, it is necessary to become part of the interdisciplinary patient-centered care team. Laboratory professionals need to view their services as contributing to patient outcomes, not just generating results.
Research on diagnostic errors and the laboratory’s role has found that failure to order appropriate diagnostic tests, including lab tests, makes up 55% of missed and delayed diagnoses in the ambulatory setting and 58% of errors in emergency departments. We know that healthcare providers don’t understand our tests as well as we do. This statistic underscores the need for Clinical Lab Scientists to interact with and provide education to ordering providers on the proper use of the testing we provide.
One way that clinical laboratory professionals can affect positive change is by collaborating with other healthcare providers to establish evidence-based decision-making guidance for ordering tests. Providing feedback to providers detailing improper test utilization patterns, both over- and under-utilization, is another way that laboratory professionals can help to reduce diagnostic errors. Other ways the laboratory can help reduce diagnostic errors include reflexive testing, consultative services and improved test reporting.
The lab can help to reduce diagnostic errors by focusing on becoming more patient-centered, educating providers on lab testing, providing consultative services, initiating feedback loops that extend beyond the walls of the lab and ensuring that we have an effective non-conformity management system.