Clin Lab. 2023 Aug 1;69(8). doi: 10.7754/Clin.Lab.2023.230118.
Diagnostic errors in clinical laboratory testing are extremely common and are major roadblocks in providing timely patient care. The purpose of this project was to investigate whether collaboration between the clinical laboratory, a diagnostic management team (DMT), and physicians who are ordering tests for a patient, resulted in improved test utilization by choosing wisely and better patient care in an academic medical center.
A retrospective study for a period of 24 months between 2017 and 2019 evaluated whether improvement of test ordering was achieved by timely interventions from the clinical laboratory and the coagulation DMT, resulting in fewer test selection errors.
The results showed about 54% improvement in diagnostic errors for coagulation test selection in 634 patients evaluated for bleeding or thrombotic disorders by DMT when compared to previous studies. Furthermore, a total of approximately 2,400 coagulation test orders for patients that were done from July 2017 to July 2018 required intervention in 12% of the cases in the initial six months. When physician education was provided, intervention was needed in only approximately 4% of the cases, an improvement of 67% that was statistically significant at p-value < 0.05. Only 28% of the cases were associated with underutilization or failure to order required initial tests. The generated cost savings from prevention of over and underutilization of laboratory tests was in the order of ~ $16,000.
The clinical laboratory and a DMT can function as an effective decision support system in decreasing errors in diagnostic test selection and facilitate knowledge among care providers regarding test results and interpretation, that may help in proper evidence-based guidelines and disease management.
临床实验室检测中的诊断错误极为常见，是及时为患者提供治疗的主要障碍。本项目旨在研究临床实验室、诊断管理团队（DMT）和为患者开检验医嘱的医生之间的合作是否通过明智选择检验项目并改善患者的医疗服务，从而提高检验的使用效率，这在学术医疗中心中尤为重要。
本研究对 2017 年至 2019 年期间的 24 个月进行了回顾性研究，评估了临床实验室和凝血 DMT 是否通过及时干预，使测试选择错误减少，从而改善检验医嘱。
与以往的研究相比，在对 634 例患有出血或血栓形成疾病的患者进行评估时，DMT 对凝血检测选择的诊断错误率降低了约 54%。此外，2017 年 7 月至 2018 年 7 月期间为患者完成的总共约 2400 次凝血检验医嘱中，有 12%的案例在最初的 6 个月内需要干预。当对医生进行教育后，仅约 4%的案例需要干预，这一改进在统计学上有显著意义（p 值<0.05），提高了 67%。仅有 28%的案例与实验室检验的过度或未充分利用有关。通过防止实验室检验的过度和未充分利用而节省的成本约为 16000 美元。
临床实验室和 DMT 可以作为一个有效的决策支持系统，减少诊断性检验选择中的错误，并使医护人员了解检验结果和解释，这可能有助于制定适当的基于证据的指南和疾病管理。
