BLOOD TEST REPORTS – Increasing Accuracy
Meena Parulekar and Sarita D’Souza - Gomantak Times – Weekender, 6 June 2010
As shocking as it may sound, blood test reports can sometimes be erroneous, the reasons for which are many.
Seeing his son with a high fever, Rahul took the boy to the doctor. On examining the boy, the doctor asked Rahul to get a blood test done to check for possible causes of the fever. Since it was late evening and he had to travel on work the next day, Rahul took his two-year-old son for a blood test to a laboratory attached to a hospital. The next day, his wife Gauri took the results to the doctor.
The doctor was shocked to see the blood test show the possibility of leukaemia. He waited till Rahul returned and asked him to take his son for another blood test — the results indicated an infection. One can only imagine the angst and turmoil that the parents would have experienced on seeing the initial test results.
As we can see from the above incident, a pathological laboratory plays a key role in diagnosing a health condition. Pathology is understood as the study and diagnosis of disease through examination of organs, tissues, body fluids. Decisions about diagnosis and treatment, hospital admission and discharge largely rest on these test results.
For a lab manager, a wrong blood report signals the need to review the lab’s working. He would do well to examine the process followed at the lab including:
- Entry of the patient and recording of his details
- Checking the tests to be conducted with the doctor’s written recommendation
- Conduct of the test and handling of the blood sample collected
- Labeling of the blood sample collected and storage conditions
- Processing of the blood sample
- Documentation of the blood report
- Handing over of the report to the patient and maintaining a copy for the record
- Timelines involved for all the above
INCORRECT REPORTS
A wrong report could be the result of the following reasons: insufficient blood for testing, wrong details on sample tube and form, wrong sample taken, no signatures, wrong type of tube, mismatch with information on lab records, tube compromised, clotting, ability of processing technician, lab equipment and so on. The lab manager could conduct a root cause analysis to find out the reason/s for the error in the report and then put in place processes to eliminate the cause of the error.
Dr P N Velingkar, who runs a lab in the heart of the city, cites quality of the reagent used, process followed and a possible error in test kit as possible reasons for errors. He suggests that labs examine standards of previous reagents used and track their performance, perform an EQAS (External Quality Assurance Services) regularly. He also opines that while sometimes a patient wants the results urgently, it is important that the lab ensures adequate time for confirmation of results.
This helps review decisions on which tests the lab can conduct, lab layout planning, quality and maintenance of equipment, putting in place proper standard operating procedure for consistent processes, proper storage facilities, training personnel and providing proper working conditions.
REDUCING ERRORS
Continuous improvement cannot rely on a single approach. An error could arise out of several individual causes working together with each other. In addition to putting in place barriers to reduce errors in test results, training initiatives create a sharp awareness of the impact and potential risk of errors in the entire process.
Pathological laboratories face issues like access to patients, availability of trained lab technicians, managing working capital and investment for equipment. Also, according to Dr J P Agarwal, director of a diagnostic centre in Hyderabad, “Some onus also rests on the doctor who does the initial diagnosis. Only when the initial diagnosis is in the right direction, the lab report will also be on the right path.” Thus, there are several operating constraints faced by path labs.
Despite having to deal with several constraints, laboratories would do well to review their working to enable consistent and accurate reports. This would form the basis for better diagnosis and effective treatment so that parents like Rahul and Gauri can rest assured about their son’s diagnosis and treatment.
Tags: Blood test report accuracy, Medical errors, Meena Parulekar, MIHM articles, Sarita D'Souza