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Plebani M. Harmonizing the post-analytical phase: focus on the laboratory report. Clin Chem Lab Med 2024; 62:1053-1062. [PMID: 38176022 DOI: 10.1515/cclm-2023-1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
The final, post-analytical, phase of laboratory testing is increasingly recognized as a fundamental step in maximizing quality and effectiveness of laboratory information. There is a need to close the loop of the total testing cycle by improving upon the laboratory report, and its notification to users. The harmonization of the post-analytical phase is somewhat complicated, mainly because it calls for communication that involves parties speaking different languages, including laboratorians, physicians, information technology specialists, and patients. Recently, increasing interest has been expressed in integrated diagnostics, defined as convergence of imaging, pathology, and laboratory tests with advanced information technology (IT). In particular, a common laboratory, radiology and pathology diagnostic reporting system that integrates text, sentinel images and molecular diagnostic data to an integrated, coherent interpretation enhances management decisions and improves quality of care.
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Affiliation(s)
- Mario Plebani
- Clinical Biochemistry and Clinical Molecular Biology, University of Padova, Padova, Italy
- Department of Pathology, University of Texas, Medical Branch, Galveston, TX, USA
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Chiu M, Garg AX, Moist L, Jain AK. A New Perspective to Longstanding Challenges with Outpatient Hyperkalemia: A Narrative Review. Can J Kidney Health Dis 2023; 10:20543581221149710. [PMID: 36654931 PMCID: PMC9841831 DOI: 10.1177/20543581221149710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023] Open
Abstract
Purpose of Review Outpatient hyperkalemia is a common problem with potentially deadly consequences. Potassium level thresholds to treat outpatient hyperkalemia are unstandardized and variable, leaving health care providers to rely on their own clinical judgment. This narrative review highlights the challenges of outpatient hyperkalemia management and includes recommendations for future studies that may standardize treatment, improve patient outcomes, and optimize health care utilization. Sources of Information PubMed, Google Scholar, and the reference lists of identified articles were used to include English, peer-reviewed studies and guidelines for this review. Methods This narrative review examines outpatient hyperkalemia from both a laboratory and clinical perspective. In addition to peer-reviewed literature, guidelines and expert consensus statements were included to highlight the inconsistencies and paucity of evidence that health care providers rely on to make clinical decisions. Key Findings There are multiple reasons why outpatient hyperkalemia management is both challenging and sub-optimal. Clinicians must discern if the potassium level result is accurate and, if so, does the result warrant referral to the emergency department. Factitious hyperkalemia, or falsely elevated potassium level results due to analytical errors, occurs frequently, but there are no ways to identify it other than for hemolyzed samples. Additionally, guidelines and expert panels are inconsistent on the thresholds for treatment and the management of hyperkalemia. Finally, there are inconsistencies between laboratories as to when and how providers are notified of results, and the suggested thresholds for urgent management. A study that integrates the expertise of clinical biochemists and clinicians is needed to inform evidence-based guidelines for the management of outpatient hyperkalemia. Limitations This was a comprehensive review of what is known and what still needs to be understood for the management of outpatient hyperkalemia. A formal tool to assess the quality of the included studies was not used and selection bias may have occurred.
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Affiliation(s)
- Michael Chiu
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada,Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada,Michael Chiu, Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, 800 Commissioners Rd E, Room A2-342 London, ON N6A 5W9 Canada.
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada,Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada,Department of Clinical Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Louise Moist
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada,Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada,Department of Clinical Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Arsh K. Jain
- Division of Nephrology, Department of Medicine, London Health Sciences Centre, Western University, London, ON, Canada,Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada,Department of Clinical Epidemiology and Biostatistics, Western University, London, ON, Canada
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Zaninotto M, Graziani MS, Plebani M. The harmonization issue in laboratory medicine: the commitment of CCLM. Clin Chem Lab Med 2022; 61:721-731. [PMID: 36383396 DOI: 10.1515/cclm-2022-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022]
Abstract
Abstract
The analytical quality of the clinical laboratory results has shown a significant improvement over the past decades, thanks to the joint efforts of different stakeholders, while the comparability among the results produced by different laboratories and methods still presents some critical issues. During these years, Clinical Chemistry and Laboratory Medicine (CCLM) published several papers on the harmonization issue over all steps in the Total Testing Process, training an important number of laboratory professionals in evaluating and monitoring all the criticisms inherent to the pre-analytical, as well as analytical and post analytical phases: from the consensus statement on the most informative testing in emergency setting, to the prevention and detection of hemolysis or to patients identification and tube labeling procedures, as far as to different approaches to harmonize hormones measurements or to describe new reference methods or to harmonize the laboratory report. During these years the commitment of the journal, devoted to the harmonization processes has allowed to improve the awareness on the topic and to provide specific instruments to monitor the rate of errors and to improve patients safety.
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Plebani M, Graziani MS, Tate JR. Harmonization in laboratory medicine: Blowin' in the wind. Clin Chem Lab Med 2019; 56:1559-1562. [PMID: 29982235 DOI: 10.1515/cclm-2018-0594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, via Nicolo Giustiniani 2, 35128 Padova, Italy
| | | | - Jillian R Tate
- Pathology Queensland, Chemical Pathology Department, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
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Yang D, Cai Q, Qi X, Xu L, Zhou Y. An evaluation of adult critical result policies in haematology in a teaching hospital in China. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:47. [PMID: 30906751 DOI: 10.21037/atm.2019.01.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Critical result (CR) reporting is one of the core policies in China, yet it varies in different hospitals. In addition, few reports of the evaluation of CR policies have been published. This study aimed to evaluate the adult CR policies for haematology in a teaching hospital. Methods The consistency was compared between CR policies in a tertiary hospital in China and the current standards, consensuses and literature. The incidences for the alert thresholds of white blood cells (WBC), haemoglobin (HgB), and platelets (PLT) and the turn-around time (TAT) for different phases of CR reporting in 2017 were investigated. On-site observation of the staff was used to assess CR implementation and compliance with CR policies. Results The clauses of adult CR policies in haematology were consistent with the requirements in the standards, consensuses and literature, and the CR items and alert thresholds were within the range reported in the literature. CRs in haematology were dominated by lower thresholds. The incidences of alerts due to WBC, HgB, and PLT levels were 37.5, 18.0 and 37.0 times/day, respectively. A total of 150 cases of CR implementation were observed on-site, and the procedures followed by the staff were consistent with the requirements of the polices. The TAT medians for CR verification in the outpatient, emergency and inpatient departments were ≤6 min. Conclusions The consistency and implementation of CR policies were both good, which ensures patient safety.
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Affiliation(s)
- Dagan Yang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Qian Cai
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Xinglun Qi
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lili Xu
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310053, China
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