Lecture 5 - Concepts of Evidence Based Decision Making in the Clinical Laboratory Flashcards
What is evidence-based practice?
In order tohave evidence-based practice, weneed evidence. The purpose is to assist in clinical decision-making. Relevant to all health professions. Ideal platform for interdisciplinary work. Different professions bring different perspectives on the evidence relating the evidence to an individual and helping the individual to reflect on the values as they consider the evidence presented to them. Allows the best use of the evidence to better clinical and health service to the patient.
Where did evidence-based practice come from?
McMaster University Medical School in the 1970s.
Short 3-year medical program.
Clinical practical experience is important.
Why do doctors order lab tests?
Patient’s best health outcome.
What is the lab’s role in evidence-based medicine?
Request for diagnostic tests represents part of a decision-making process.
Relevance of test results to the patient’s clinical situation.
Quality of test.
Evaluation of new test.
Principle of evidence-based lab medicine?
Is the test results accurate?
Tests must meet accuracy and precision criteria.
Pre-analytic criteria must be understood.
Tests must give the answer to diagnostic accuracy.
Factors affecting the quality of tests?
- Accuracy
- Precision
- Test range
- Interferences
- Pre-analytic errors
- Test errors
- Sample stability
- Turn around time (TAT)
- Technical performance
Technical performance?
- Quality of staff
- Quality of the test
- Staff training
- Assessment of competencies
- Co. Ed to maintain competencies
- Clinical Guidelines
- Outcome
- Diagnostic accuracy or inaccuracy
- Good or bad patient outcome
What are pre-analytical errors?
- Sample collection and patient ID error
- Hemolysis
- Not sufficient quantity (NSQ)
- Incorrect samples
- Clotted samples
- Incorrect ID
- Lack of signature
- Sample not on the ice
- Tube broke in the centrifuge
How do you prevent pre-analytical errors?
- Ordering and receiving tests in the LIS
- Centrifugation
- Specimen Management
- Storage/Stability of specimen
- Quality control (QC)
What are possible sources of analytical errors?
- Patient preparation (effects of fasting, posture, exercise, and biological variation)
- Instrument calibration
- Reagents
- Method performance (accuracy and precision).
- Technologist expertise and training
- Impact of the incorrect test result on patient outcome
What are possible sources of post-analytic errors?
- Results released without result verification
- Critical values are not communicated immediately
- Unrecorded test results
- Results released outside of TAT
- All tests performed not performed as requested
- Result printout attached to the wrong request
- Left over sample not retained as the policy
- Laboratory requests with results lost
- Request with incorrect unit of reporting
Clinical benefit?
The right patient >
Lab generate the right result >
Right patient outcome
Researching the true evidence - responding to inquiries from clinicians or peers?
what test to use
- How to use a test
- The meaning of a specific result
- What action to take on receipt of a result
Researching the true evidence - introducing a new test?
- A clinician requests a new test
- A manager wants a business case for a new test
- A manager wants an implementation program
- A policymaker is considering a new screening program
Researching the true evidence - decommissioning an old test or another part of the service?
- Identifying where the new tests will impact the care pathway
- Identifying opportunities for disinvestment
