Understanding Laboratory Test Results: Conditions for Appropriate Use of laboratory Tests

1987 ◽  
Vol 71 (4) ◽  
pp. 639-652 ◽  
Author(s):  
J. Sanford Schwartz
Keyword(s):  
Laboratory Test ◽  
Laboratory Tests ◽  
Test Results ◽  
Appropriate Use ◽  
Laboratory Test Results

Reduction of Laboratory Utilization in the Intensive Care Unit

2016 ◽  
Vol 32 (8) ◽  
pp. 500-507 ◽  
Author(s):  
Samih Raad ◽  
Rachel Elliott ◽  
Evan Dickerson ◽  
Babar Khan ◽  
Khalil Diab
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Laboratory Test ◽  
Laboratory Tests ◽  
Routine Laboratory ◽  
Test Results ◽  
Staff Education ◽  
Arterial Blood ◽  
Laboratory Test Results ◽  
Order Sets

Objective: In our academic intensive care unit (ICU), there is excess ordering of routine laboratory tests. This is partially due to a lack of transparency of laboratory-processing costs and to the admission order plans that favor daily laboratory test orders. We hypothesized that a program that involves physician and staff education and alters the current ICU order sets will lead to a sustained decrease in routine laboratory test ordering. Design: Prospective cohort study. Setting: Academic closed medical ICU (MICU). Patients: All patients admitted to the MICU. Methods: We consistently educated residents, faculty, and staff about laboratory test costs. We removed the daily laboratory test option from the admission order sets and asked residents to order needed laboratory test results every day. We only allowed the G3+I-STAT (arterial blood gas only) cartridges in the MICU in hopes of decreasing duplicative laboratory test results. We added laboratory review to the daily rounding checklist. Measurement and Main Results: Total number of laboratory tests per patient-day decreased from 39.43 to an average of 26.74 ( P <.001) over a 9-month period. The number of iSTAT laboratory tests per patient-day decreased from 7.37 to an average of 1.16 ( P < .001) over the same time period. The number of iSTAT/central laboratory processing duplicative laboratory tests per patient-day decreased from 0.17 to an average of 0.01 ( P < .001). The percentage of patients who have daily laboratory test orders decreased from 100% to an average of 11.94% ( P <. 001). US$123 436 in direct savings and US$258 035 dollars in indirect savings could be achieved with these trends. Intensive care unit morbidity and mortality were not impacted. Conclusion: A simple technique of resident, nursing, and ancillary staff education, combined with alterations in order sets using electronic medical records, can lead to a sustained reduction in laboratory test utilization over time and to significant cost savings without affecting patient safety.

scholarly journals Association of Test Results for 33 Frequently Used Laboratory Tests with Body Mass Index (BMI)

2020 ◽  
pp. 1-4
Author(s):  
Anders Larsson ◽  
Anders Larsson ◽  
Johan Ärnlöv ◽  
Johanna Helmersson-Karlqvist ◽  
Lars Lind ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Laboratory Test ◽  
Body Mass ◽  
Cystatin C ◽  
Apolipoprotein B ◽  
Laboratory Tests ◽  
Hdl Cholesterol ◽  
Apolipoprotein A1 ◽  
Test Results ◽  
Laboratory Test Results

Once considered a problem only for high-income countries, obesity rates are now rising worldwide. When evaluating test results from obese patients it is important to be aware of the effect of obesity on individual laboratory test results. The aim of the present study was to study the association between body mass index (BMI) and a group of frequently requested laboratory tests to evaluate which of these analytes that are affected by BMI. We analyzed the association between body mass index (BMI) and Alanine aminotransaminase (ALT), Albumin, Alkaline phosphatase, Pancreatic amylase, Apolipoprotein A1, Apolipoprotein B, Apolipoprotein B/Apolipoprotein A1 ratio, Aspartate aminotransferase (AST), AST/ALT ratio, Bilirubin, Calcium, Calprotectin, Cholesterol, HDL-cholesterol, Creatinine kinase (CK), Creatinine, C-reactive protein, Cystatin C, Gamma-glutamyl transferase (GGT), Iron, Iron saturation, Lactate dehydrogenase (LDH), Magnesium, Phosphate, Transferrin, Triglycerides, Urate, Urea, Zink, Hemoglobin, Platelet count and White blood cell count in an 80-year old population (n=531, 266 females and 265 males). There were significant Spearman rank associations between BMI and laboratory test results for several of the studied markers in both females and males. The strongest associations with BMI were noted for ALT, Apolipoprotein A1, HDL-cholesterol, Hemoglobin, CRP, Cystatin C, Triglycerides and Urate. In conclusion, several of the most frequently used laboratory markers are significantly associated with BMI. To be able to correctly interpret a test result it is important to be aware of the effects of BMI on the test results.

scholarly journals Reminders of Drug Effects on Laboratory Test Results

2000 ◽  
Vol 46 (9) ◽  
pp. 1395-1400 ◽  
Author(s):  
Marita Kailajärvi ◽  
Timo Takala ◽  
Paula Grönroos ◽  
Nils Tryding ◽  
Jorma Viikari ◽  
...  
Keyword(s):  
Laboratory Test ◽  
Laboratory Tests ◽  
Drug Effects ◽  
Study Drug ◽  
Test Results ◽  
Potential Drug ◽  
Reminder System ◽  
Patient Medication ◽  
Laboratory Test Results ◽  
Laboratory Results

Abstract Drug effects on laboratory test results are difficult to take into account without an online decision support system. In this study, drug effects on hormone test results were coded using a drug-laboratory effect (DLE) code. The criteria that trigger the reminders were defined. To issue reminders, it was necessary to write a computer program linking the DLE knowledge base with databases containing individual patient medication and laboratory test results. During the first 10 months, 11% of the results from hormone samples were accompanied by one or more DLE reminders. The most common drugs to trigger reminders were glucocorticoids, furosemide, and metoclopramide. Physicians facing the reminders completed a questionnaire on the usefulness of the reminders. All respondents considered them useful. In addition, DLE reminders had caused 74% of respondents to refrain from additional, usually performed examinations. In conclusion, drug effects on laboratory tests should always be considered when interpreting laboratory results. An online reminder system is useful in displaying potential drug effects alongside test results.

The Usefulness of Laboratory Tests in Health-Screening Programs

1973 ◽  
Vol 19 (4) ◽  
pp. 366-372 ◽  
Author(s):  
David L Sackett
Keyword(s):  
Laboratory Test ◽  
Laboratory Tests ◽  
Health Screening ◽  
Test Results ◽  
Screening Programs ◽  
Laboratory Screening ◽  
Rare Exception ◽  
Laboratory Test Results ◽  
The Mean ◽  
Regression Toward The Mean

Abstract I discuss pitfalls in laboratory-screening programs: regression toward the mean on repeated biochemical determinations; the problem of defining normalcy in the interpretation of laboratory test results; and a remarkable professional myopia in which clinical chemists have, with rare exception, failed to accept responsibility for evaluating whether the programs in which they are engaged are of benefit to patients.

Evaluation of Techniques for the Presentation of Laboratory Data. II: Accuracy of Interpretation

1997 ◽  
Vol 36 (01) ◽  
pp. 17-19 ◽  
Author(s):  
J. O. O. Hoeke ◽  
B. Bonke ◽  
R. van Strik ◽  
E. S. Gelsema ◽  
R. Verheij
Keyword(s):  
Reaction Time ◽  
Laboratory Test ◽  
Clinical Experience ◽  
Laboratory Tests ◽  
Laboratory Data ◽  
Reaction Time Experiment ◽  
Test Results ◽  
Laboratory Test Results

Abstract:Four tabular and two graphical techniques for the presentation of laboratory test results were evaluated in a reaction time experiment with 25 volunteers. Artificial variables and values were used to represent sets of 12 laboratory tests to eliminate the possible effects of clinical experience. Analyses focused on four types of errors in interpretation. Color-coded tables and one of the color-coded graphs greatly (2.8 times or better) reduced the number of incorrectly classified test results, as compared to the reference presentation technique. This was mainly due to a reduction of the number of abnormal test results that were not noticed by the subjects when using these presentation techniques.

scholarly journals Redundant laboratory testing on referral from general practice to the outpatient clinic

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0134
Author(s):  
Bram EL Vrijsen ◽  
Maarten J ten Berg ◽  
Wouter W van Solinge ◽  
Jan Westerink
Keyword(s):  
General Practitioner ◽  
Laboratory Test ◽  
Outpatient Clinic ◽  
Laboratory Testing ◽  
Laboratory Tests ◽  
Referral Letter ◽  
Test Results ◽  
Normal Test ◽  
Laboratory Test Results ◽  
High Level

BackgroundInappropriately repeated laboratory testing is a commonly occurring problem. However, this has not been studied extensively in the outpatient clinic after referral by general practitioners.AimThe aim of this study was to investigate how often laboratory tests ordered by the general practitioner were repeated on referral to the outpatient clinic, and how many of the normal test results remained normal on repetition.Design & settingThis is a post hoc analysis of a study on laboratory testing strategies in patients newly referred to the outpatient clinic.MethodAll patients who had a referral letter including laboratory test results ordered by the general practitioner were included. These results were compared to the laboratory test results ordered in the outpatient clinic.ResultsData were available for 295 patients, 191 of which had post-visit testing done. In this group, 56% of tests ordered by the general practitioner were repeated. Tests with abnormal results were repeated more frequently than tests with normal results (65% vs 53%; P<0.001). A longer test interval was associated with slightly smaller odds of tests being repeated (OR 0.97 [0.95–0.99]; P=0.003). Of the tests with normal test results that were repeated, 90% remained normal. This was independent of testing interval or testing strategy.ConclusionLaboratory tests ordered by the general practitioner are commonly repeated on referral to the outpatient clinic. The number of test results remaining normal on repetition suggests a high level of redundancy in laboratory test repetition.

scholarly journals Semantic Integration of Clinical Laboratory Tests from Electronic Health Records for Deep Phenotyping and Biomarker Discovery

2019 ◽  
Author(s):  
Xingmin Aaron Zhang ◽  
Amy Yates ◽  
Nicole Vasilevsky ◽  
JP Gourdine ◽  
Leigh C. Carmody ◽  
...  
Keyword(s):  
Laboratory Test ◽  
Electronic Health Record ◽  
Laboratory Tests ◽  
Health Record ◽  
Phenotype Ontology ◽  
Test Results ◽  
Human Phenotype ◽  
Laboratory Test Results ◽  
Electronic Health ◽  
Deep Phenotyping

AbstractElectronic Health Record (EHR) systems typically define laboratory test results using the Laboratory Observation Identifier Names and Codes (LOINC) and can transmit them using Fast Healthcare Interoperability Resource (FHIR) standards. LOINC has not yet been semantically integrated with computational resources for phenotype analysis. Here, we provide a method for mapping LOINC-encoded laboratory test results transmitted in FHIR standards to the Human Phenotype Ontology (HPO) terms. We annotated the medical implications of 2421 commonly used laboratory tests with HPO terms. Using these annotations, a software assesses laboratory test results and converts each into an HPO term. We validated our approach with EHR data from 15,681 patients with respiratory complaints and identified known biomarkers for asthma. Finally, we provide a freely available SMART on FHIR application that can be used within EHR systems. Our approach allows reusing readily available laboratory tests in EHR for deep phenotyping and using the hierarchical structure of HPO for association studies with medical outcomes and genomics.One Sentence SummaryWe present an approach to semantically integrating LOINC-encoded laboratory data with the Human Phenotype Ontology and show that the integrated LOINC data can be used to identify biomarkers for asthma from electronic health record data.

scholarly journals A NEW POSSIBILITY FOR SURVEILLANCE: DO WE IDENTIFY ALL CASES OF LEPTOSPIROSIS?

2015 ◽  
Vol 57 (5) ◽  
pp. 443-446 ◽  
Author(s):  
Raissa Matos FONTES ◽  
Luciano Pamplona de Góes CAVALCANTI ◽  
Augusto César Aragão OLIVEIRA ◽  
Laiane Fernanda de Melo BEZERRA ◽  
Almira Maria Monteiro GOMES ◽  
...  
Keyword(s):  
Health Services ◽  
Laboratory Test ◽  
Laboratory Tests ◽  
Northeast Brazil ◽  
Test Results ◽  
Febrile Disease ◽  
Igm Antibodies ◽  
Laboratory Test Results ◽  
The City

SUMMARY Leptospirosis is a febrile disease with a typically underestimated global incidence, especially in regions where dengue is endemic. Therefore, it is difficult to accurately determine the number of leptospirosis cases in these areas, which contributes to significant under-reporting this disease. In this study, we estimated the number of possible leptospirosis cases among dengue-like cases that were reported during 2008, 2010, and 2012 in the city of Fortaleza, northeast Brazil. Patients were evaluated for dengue and leptospirosis using immunoenzymatic tests for IgM antibodies that were specific to each pathogen. Among the suspected cases of dengue that resulted as negative in laboratory tests, 10.8% (2008), 19.2% (2010), and 30.8% (2012) were confirmed to be leptospirosis. Considering the cases reported by the surveillance authority as dengue that were subsequently discarded based on the laboratory test results, we estimate that the number of actual leptospirosis cases may be 26 to 49 times higher than those diagnosed and reported by the Health Services. Furthermore, we believe that approximately 20% of dengue-like cases may be leptospirosis cases in areas where the two diseases are endemic.

scholarly journals Use of laboratory test results in patient management by clinicians in Malawi

2015 ◽  
Vol 4 (1) ◽  
Author(s):  
Kundai Moyo ◽  
Carol Porter ◽  
Ben Chilima ◽  
Reuben Mwenda ◽  
Mark Kabue ◽  
...  
Keyword(s):  
Laboratory Test ◽  
Laboratory Tests ◽  
Patient Management ◽  
Cross Sectional Study ◽  
Laboratory System ◽  
Test Results ◽  
Cross Sectional ◽  
Key Informants ◽  
Laboratory Test Results

Background: Malawi has a high burden of infectious disease. The expansion of programmes targeting these diseases requires a strong laboratory infrastructure to support both diagnosis and treatment.Objectives: To assess the use of laboratory test results in patient management and to determine the requirements for improving laboratory services.Methods: A cross-sectional study was conducted in 2012 to survey practising clinicians.Two hospitals were purposively selected for observations of clinicians ordering laboratory tests. Twelve management-level key informants were interviewed. Descriptive statistics were conducted.Results: A total of 242 clinicians were identified and 216 (89%) were interviewed. Of these, 189 (87%) reported doubting laboratory test results at some point. Clinicians most often doubted the quality of haematology (67%), followed by malaria (53%) and CD4 (22%) test results. A total of 151 (70%) clinicians reported using laboratory tests results in patient management. Use of laboratory test results at all times in patient management varied by the type of health facility (P < 0.001). Ninety-one percent of clinicians reported that laboratories required infrastructure improvement. During 97 observations of clinicians’ use of laboratory test results, 80 tests were ordered, and 73 (91%) of these were used in patient management. Key informants reported that the quality of laboratory services was good and useful, but that services were often unavailable.Conclusion: Gaps in the public laboratory system were evident. Key recommendations to enhance the use of laboratory test results in patient management were to strengthen the supply chain, reduce turn-around times, improve the test menu and improve the laboratory infrastructure.

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