Bringing the clinical laboratory into the strategy to advance diagnostic excellence

Abstract

Objectives: Clinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses.

Content: Innovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors.

Summary: An expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice.

Outlook: There are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.

Keywords: diagnostic error; diagnostic excellence; laboratory practice; quality.

Figure 1:. The total testing process describes the lifecycle of a clinical laboratory test [6, 7].

The process is divided into the pre-analytic, analytic, and post-analytic phases of testing. The pre-analytic phase includes all steps that occur prior to perforrning the clinical test. The analytic phase includes performance of test procedures, quality control, calibration, and verification procedures, and documentation of testing data. The post-analytic phase includes all steps that occur after the clinical test is performed. The pre- and post- analytic phases of testing include steps that occur in both the laboratory and patient-care settings. Dotted lines indicate aspects more recently entering practice that provide patients direct access to test results and access to web-based and resources that contain information about clinical laboratory testing.