Patient Safety and Quality in Laboratory and Hemostasis Testing: A Renewed Loop?

Abstract

More than three decades ago, George Lundberg first introduced the concept of the brain-to-brain loop for laboratory diagnostics. According to this pioneering model, the first step in the loop involves the selection of laboratory tests in the brain of the physician caring for the patient, and the final step is the transmission of test results back to the ordering physician. There are several intermediary steps, some of which are preanalytical (e.g., identification of patient and blood samples, the process of blood collection, and specimen handling); some are analytical and relate to the actual performance of the test(s); whereas others are postanalytical and involve release of test results into the medical record and further steps such as the physician's reaction to laboratory information, their interpretation of these results, and subsequent appropriate clinical action. Hemostasis testing should also be viewed within such a paradigm, so that quality throughout the total testing process can be assured. For hemostasis testing, particular attention is required to ensure provision of appropriate test samples in the preanalytical phase. Nevertheless, the timeliness of testing and an appropriate interpretation of test results are also paramount. This article overviews the concept of quality testing within hemostasis as critical to ensuring patient safety and optimal clinical and therapeutic management.

Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in Northwest Nigeria

“…5 The first step in this loop model involves the selection of appropriate laboratory tests in the brain of the physician, which is then communicated through the LRF. This is followed by numerous intermediary steps, such as identification of the patient, specimen collection and specimen handling; and then by the actual specimen analysis in the laboratory.…”

Laboratory hemostasis: milestones in Clinical Chemistry and Laboratory Medicine

“…Quality in laboratory diagnostics is irrecusable, since spurious results obtained on unsuitable specimens may negatively bias the clinical decision-making and jeopardize patient safety. Laboratory errors may develop from any step throughout the testing process [47,48] , but are characteristically prevalent in the manually intensive activities of the preanalytical phase [49 -51] . Although the classical model of the " brain-to-brain loop " applies to all fields of laboratory medicine, its significance is substantial for hemostasis testing [48] .…”

“…Laboratory errors may develop from any step throughout the testing process [47,48] , but are characteristically prevalent in the manually intensive activities of the preanalytical phase [49 -51] . Although the classical model of the " brain-to-brain loop " applies to all fields of laboratory medicine, its significance is substantial for hemostasis testing [48] . The vast armamentarium of laboratory hemostasis share some basic requisites and quality characteristics of traditional clinical chemistry, immunochemistry and hematology diagnostics, but there are also some specific preanalytical, analytical and postanalytical requirements [52 -54] .…”

Testing volume is not synonymous of cost, value and efficacy in laboratory diagnostics

“…Since the IVD testing market is unequivocally one of the brightest spots in healthcare economy, public policies should aim to foster continued growth rather than depression of this area. Incidentally, there is mounting evidence that some other strategies, such as appropriateness of test requests and better utilization of test results [11,12] , may be pursued for delivering a better IVD testing without spending more.…”