In this article:
- Build relationships and communicate effectively with physicians
- Offer results in a useful way and help interpret them
- Stay on top of new guidelines
Best practices are techniques or processes that help to accomplish tasks while hopefully reducing the risk of complications, and increasing efficiency and effectiveness. These are usually not formalized standards, but common sense methods that lead to a desired outcome.Of course “best” practices for a lab can evolve with experience. As your lab gets up and running, you may find these basic best practices helpful when reporting results to your physicians.
1. Know Your Physicians
According to Gregory A. Storch, MD, Director of the Virology Laboratory at St. Louis Children’s Hospital, it is very important to know who are the main physician constituents who would be interested in molecular testing. “There is going to be a relatively small group of specialists that labs should establish a relationship with,” he said. “They might not take advantage of it, but at least offer that relationship for communication, since the physician will be reviewing the results.”
2. Report Results in a Useful Way
Results should be reported in a format that your physicians like and can understand easily. This is where open dialogue is so beneficial. You can get their opinions on explanatory comments, prioritization of results, graphic elements, etc. “Hepatitis and HIV patients that have chronic infections may have viral load measured repeatedly. It is helpful to have a tabular or graphical format so the physician can easily see and compare changes over time. You don’t want a different page or screen for each result,” suggests Dr. Storch.
3. Help Interpret Results
“There is often a core group of physicians who are very knowledgeable, but another broader group of physicians who may not order this type of test very often,” said Dr. Storch. “They may need more help interpreting complex test results.” He suggests embedding comments in the lab computer system to help explain performance characteristics of the test, limits of performance, or what level of difference between two samples from the same patient can be considered to be different from a statistical standpoint.
4. Investigate Computer Limitations
A lab depends on the computer system, but that computer can put limits on what a lab can offer. A physician may tell you what they want, but the computing staff will tell you what is actually possible within the system. “A lab director needs to understand what those limitations are and work with the computing staff months in advance of doing a new test so you can provide results in the right way,” said Dr. Storch.
5. Set Expectations on Timing
Some physicians may want immediate notification of results. Your lab needs to set expectations on turnaround time. This can depend on the volume of samples that go through the lab, how the test is configured, how many specimens you have to run to avoid wasting, and more. Once again, know who the key physicians are and keep communication ongoing to avoid confusion and frustration.
6. Watch for Red Flags
If the lab sees a result that has dropped or increased more that expected, bring it to the physician’s attention. Delta checks are in place to catch any difference between a patient's present laboratory result and the previous result that exceeds a predefined limit. You should be able to rule out mislabeling, clerical error or possible analytical error. There may be a need for additional or repeat testing.
7. Employ a Specimen Handling System
It is crucial to have a system in place so you know if a specimen was not handled correctly, and you can notify a physician in that event. Be sure to inform physicians, nurses, physician assistants, and office staff who receive and process samples about the optimal specimen type and specimen handling requirements. Brief them on collection and how a poor quality specimen could affect the test result.
8. Train for New Tests
As you begin to offer new tests at your facility, the clinician and the lab director need to be on the same page. For instance, for HPV testing, OB-GYN doctors may not have much experience with molecular testing. Dr. Storch recommends meeting with physicians in grand rounds where testing and reporting is discussed, as well as low-risk types vs. high-risk types. “Molecular testing often provides new information that was not previously available, and it may bring about a whole new way of taking care of patients. Optimum value needs to be realized,” he said.
9. Stay Informed
Your lab should be up-to-date on the latest literature about best practices to see what the testing experts recommend. There will always be different schools of thought on best practices. If you stay in the range of good lab practices and are working closely with your physicians, your lab’s best practices will be accepted and successful.