Efficacy of clinical laboratory: Therapeutic TAT, safety, and medical errors

Abstract

Health care services rely on continued technological advances and management of the operational systems for optimum reduction of medical errors. Significant gains in health care outcomes as indicated by recorded increases in life expectancies have been achieved due to the availability and application of technological advances for medical services. The inadequacies in the application of these systems for maximum benefit of the health care systems have however been the subject of recent publications dealing with patient safety and medical errors [Kohn Linda T, Corrigan Janet M, Donaldson Molla S, editors. To err is human: building a safer health system. Washington, DC: Institute of Medicine, National Academy Press; 2000; Brennan TA, Leape LL. Adverse events, negligence in hospitalized patients: results from the Harvard Medical Practice Study. Perspect Healthc Risk Manage 1991;11(2):2–8; Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. New Engl J Med 1991;324(6):377–84; Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000;38(3):261–71]. Estimates by the Institute of Medicine (IOM) indicate that approximately 44,000–98,000 deaths occur each year as a consequence of inadequate safety and failure to prevent errors in the health care system. This puts medical errors in the top four leading causes of deaths per the IOM report. Other studies in the USA states of Colorado, Utah, and New York suggest that medical errors occur in 2–4% of hospitalizations. The paper by Raab et al. denoted a 6.7% discrepancy between original report and secondary case review, and 5% of the discrepancies have modest to significant effect on patient care [Raab SS, Grzybicki DM, Zarbo RJ, Meier FA, Geyer SJ, Jensen C. Anatomic pathology databases and patient safety. Arch Pathol Lab Med 2005;129:459–66]. This presentation focuses on the health care safety and medical errors relative to clinical laboratory. The impact of laboratory operations with resultant delays in test turn around times (TAT) and other laboratory errors on the health care services are presented. The role of governmental (US Department of Health and Human Services) and non-governmental regulatory agencies (CAP, AACC, IFCC, CLSI, etc) in mitigating these clinical laboratory errors is discussed. The use of payment system as a mechanism for improving the quality of laboratory services is also presented to illustrate the checks and balance systems aimed at reduction of medical errors. The presentation will conclude with the recommendation that majority of the clinical laboratory delays in turn around time and other errors can be prevented with appropriate analytical systems and operational processes under the overall guidance of the right regulatory agencies.