Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Ann Clin Biochem. 2013 Jul;50(Pt 4):306-14. doi: 10.1177/0004563213476486. Epub 2013 Jun 13.
The purpose of laboratory medicine is to facilitate better decision making in clinical practice and healthcare delivery. Decision making implies an unresolved issue, problem or unmet need. The most important criterion for any investigation to be of value in clinical practice is that it addresses an unmet need. The different ways in which laboratory investigations are utilized in patient care can be represented in the form of questions. It is important that these questions are articulated to highlight the variables that will impact on the effectiveness of the investigation in the scenario being considered. These variables include the characteristics of the patient (or population) and clinical setting, the nature of the decision and action taken on receipt of the test result and the expected outcome. Asking a question is the first step of the evidence-based laboratory medicine (EBLM) cycle, the other steps being acquiring the evidence, critically appraising the evidence, applying the evidence and auditing use of the evidence. Getting the question right determines the quality of the whole process, thus, defines the quality in practice of laboratory medicine. Whilst the main focus of the EBLM cycle is to provide a strong evidence base for use in clinical practice, it is clear that the five steps are equally applicable in commissioning, delivery and audit (performance management) of services. Asking the right question is crucial to improving the quality of evidence, and practice, in laboratory medicine, and should be used in routine laboratory medicine practice and management throughout healthcare.
医学检验的目的是促进临床实践和医疗保健服务中更好的决策制定。决策意味着存在未解决的问题、难题或未满足的需求。任何检验在临床实践中有价值的最重要标准是它能够满足未满足的需求。实验室检验在患者护理中的不同应用方式可以用问题的形式来表示。重要的是，这些问题需要明确表达，以突出影响在考虑的情况下检验效果的变量。这些变量包括患者（或人群）和临床环境的特征、决策的性质以及收到检验结果后采取的行动以及预期的结果。提出问题是循证检验医学（EBLM）循环的第一步，其他步骤包括获取证据、批判性评估证据、应用证据和审核证据的使用。正确提出问题决定了整个过程的质量，从而定义了检验医学实践中的质量。虽然 EBLM 循环的主要重点是为临床实践提供强有力的证据基础，但很明显，这五个步骤在服务的委托、提供和审核（绩效管理）中同样适用。提出正确的问题对于提高检验医学中证据和实践的质量至关重要，应在整个医疗保健领域的常规检验医学实践和管理中使用。
