Clinical Diagnostic Tests by PhD Michael Laposata MD

Author:PhD, Michael Laposata MD,
Language: eng
Format: epub
Publisher: Springer Publishing Company, Inc.
Published: 2016-08-10T16:00:00+00:00

STANDARDS OF CARE

Physicians must be selective in ordering laboratory tests. Order what is medically necessary for a patient based on the symptoms and diagnosis. It is not appropriate to screen for an abnormality using large panels of tests. Manufacturers should provide the ability to select individual tests on their instrumentation instead of forcing panel configurations that encourage unnecessary tests.

While grouping tests can facilitate physician ordering, panels of tests encourage overutilization of unnecessary testing.

Laboratories must match test cutoffs for screening and confirmation tests for drug testing.

Physicians and laboratories must consider the possibility of deception in drug testing. Patients can dilute, adulterate, or substitute their samples in order to generate false-negative drug test results.

Laboratories must educate physicians on the limitations of drug screening tests, common sources of false-positive and false-negative test results.

Results should only be reported to an appropriate number of significant figures. Assay performance should reflect technical and biologic variation and a laboratory must work with physicians to ensure that reporting format matches the true assay performance and medical needs.

Critical values are life-threatening results that require immediate, interruptive contact of the ordering physician or a designee who can take clinical action. Ordering clinicians must be aware of this expectation and accept responsibility for patient management.

Clinicians should rarely treat solely based on the screening test results for drugs of abuse. Drug screens can have false-positive cross-reactivities that require confirmatory testing by a more specific method to appropriately identify a specific drug and metabolite.

Administration of the next dose of antibiotics, especially vancomycin, should rarely be held pending laboratory results, creating a false need for laboratory urgency when, for most patients, a dose does not need to be held. Pharmacists should assist the laboratory in educating clinical staff on the proper timing of specimen collection and dose administration for therapeutic monitoring.

Laboratories must understand their automated processes, work to maximize efficiency, and limit stat requests to those patients who urgently require the faster turnaround time.

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