BACKGROUND: Early notification of critical values by the clinical laboratory to the treating physician is a requirement for accreditation and is essential for effective patient management. Many laboratories automatically repeat a critical value before reporting it to prevent possible misdiagnosis. Given today's advanced instrumentation and quality assurance practices, we questioned the validity of this approach. We performed an audit of repeat-testing in our laboratory to assess for significant differences between initial and repeated test results, estimate the delay caused by repeat-testing and to quantify the cost of repeating these assays. METHODS: A retrospective audit of repeat-tests for sodium, potassium, calcium and magnesium in the first quarter of 2013 at Tygerberg Academic Laboratory was conducted. Data on the initial and repeat-test values and the time that they were performed was extracted from our laboratory information system. The Clinical Laboratory Improvement Amendment criteria for allowable error were employed to assess for significant difference between results. RESULTS: A total of 2308 repeated tests were studied. There was no significant difference in 2291 (99.3%) of the samples. The average delay ranged from 35 min for magnesium to 42 min for sodium and calcium. At least 2.9% of laboratory running costs for the analytes was spent on repeating them. CONCLUSIONS: The practice of repeating a critical test result appears unnecessary as it yields similar results, delays notification to the treating clinician and increases laboratory running costs.
BACKGROUND: Early notification of critical values by the clinical laboratory to the treating physician is a requirement for accreditation and is essential for effective patient management. Many laboratories automatically repeat a critical value before reporting it to prevent possible misdiagnosis. Given today's advanced instrumentation and quality assurance practices, we questioned the validity of this approach. We performed an audit of repeat-testing in our laboratory to assess for significant differences between initial and repeated test results, estimate the delay caused by repeat-testing and to quantify the cost of repeating these assays. METHODS: A retrospective audit of repeat-tests for sodium, potassium, calcium and magnesium in the first quarter of 2013 at Tygerberg Academic Laboratory was conducted. Data on the initial and repeat-test values and the time that they were performed was extracted from our laboratory information system. The Clinical Laboratory Improvement Amendment criteria for allowable error were employed to assess for significant difference between results. RESULTS: A total of 2308 repeated tests were studied. There was no significant difference in 2291 (99.3%) of the samples. The average delay ranged from 35 min for magnesium to 42 min for sodium and calcium. At least 2.9% of laboratory running costs for the analytes was spent on repeating them. CONCLUSIONS: The practice of repeating a critical test result appears unnecessary as it yields similar results, delays notification to the treating clinician and increases laboratory running costs.
Authors: Julie Lv Shaw; Christopher R McCudden; David A Colantonio; Ronald A Booth; Danny C Lin; Ivan M Blasutig; Thomas Moran; Dana Trofimczuk; Chantal Carriere; Anas Gharra; Cheryl Portelance; Chantal Tremblay; Dianne Dupaul; Nathalie Breton; Merina Angelkovski; Chetan Jariwala; Maureen Embleton; Christine Campbell; Kristina Groulx; Karen Larmour Journal: Pract Lab Med Date: 2020-10-19
Authors: Stefanie Neubig; Anne Grotevendt; Anders Kallner; Matthias Nauck; Astrid Petersmann Journal: Biochem Med (Zagreb) Date: 2017-02-15 Impact factor: 2.313
Authors: Lucius C Imoh; Mubanga Mutale; Christopher T Parker; Rajiv T Erasmus; Annalise E Zemlin Journal: Biochem Med (Zagreb) Date: 2016 Impact factor: 2.313