Patient Safety and the Medical Laboratory Using the IOM Aims

Safe Laboratory Services Medical laboratory services should provide care that improves patient outcomes. Errors or defects can occur at any step of the laboratory testing process. The majority of errors are identified in the pre-analytic (46.0 – 68.2%) and post-analytic (18.5 – 47.0%)² phases. Error rate benchmarks are difficult to calculate because no standard mechanism exists to report errors for any phase of laboratory testing. Studies have reported error rate metrics as errors per sample,³ per analyses,⁴ per requisition⁵ and per billable test.⁶ Nonetheless, measuring error rates, followed by process or technology enhancements, ameliorates system problems, improves the total testing process (TTP), and enhances patient outcomes.^{3,4, 7}

The first and last steps in the TTP, ‘selecting the correct test to perform’ and ‘accurately interpreting test results’ are at the greatest risk for errors.⁸ Guidelines for test selection and reflexive testing protocols reduces the number of test ordering errors by decreasing unnecessary and ineffective test utilization.⁹ Examples of effective use of reflexive testing includes performing factor assays if a mixing study indicates a possible factor deficiency; performing antibody identification following a positive antibody screen in transfusion services; and performing a thyroxine (T4) if the thyroid stimulating hormone (TSH) is greater than an established threshold.⁹

An estimated 5%…

ABBREVIATIONS: ADA, American Diabetes Association; AIC, hemoglobin A_1C; EBM, evidence-based medicine; EBMgt, evidence-based management; ED, emergency department; EHR, electronic health record; LOS, length of stay; POCT, point-of-care testing; T4, thyroxine; TAT, turnaround time; TSH, thyroid stimulating hormone; TTP, total testing process.