Keywords
Critical alerts
QMS
Biochemistry reporting
Medical decisions
How to Cite
Abstract
It is a professional requirement for clinical biochemists to provide Interpretative Remarks (IR). Few clinical labs give any comments at all, and the majority of laboratories just employ pre-written remarks on the report. In addition to physicians, other medical professionals, and occasionally even patients themselves, seek laboratory experts for guidance on data interpretation. The quality of interpretative remarks is impacted by the unavailability of the patient's medical record, restricted communication with the doctors, and a lack of professional experience. The purpose of this paper is to highlight how crucial it is to provide interpretive commentary in the context of responsibility for medical biochemists. In a similar vein, this paper offers guidance to those who offer interpretations.
References
Plebani M. The detection and prevention of errors in laboratory medicine. Ann Clin Biochem. 2010 Mar;47(Pt 2):101-10. https://doi.org/10.1258/acb.2009.009222. Epub 2009 Dec 1. PMID: 19952034.
Laposata M, Dighe A. "Pre-pre" and "post-post" analytical error: high-incidence patient safety hazards involving the clinical laboratory. Clin Chem Lab Med. 2007;45(6):712-9. https://doi.org/10.1515/CCLM.2007.173. PMID: 17579522.
Gandhi TK, Kachalia A, Thomas EJ, Puopolo AL, Yoon C, Brennan TA, Studdert DM. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006 Oct 3;145(7):488-96. https://doi.org/10.7326/0003-4819-145-7-200610030-00006. PMID: 17015866.
Wahls TL, Cram PM. The frequency of missed test results and associated treatment delays in a highly computerized health system. BMC Fam Pract. 2007 May 22;8:32. https://doi.org/10.1186/1471-2296-8-32. PMID: 17519017; PMCID: PMC1891295.
Plebani M, Sciacovelli L, Aita A, Padoan A, Chiozza ML. Quality indicators to detect pre-analytical errors in laboratory testing. Clin Chim Acta. 2014 May 15;432:44-8. https://doi.org/10.1016/j.cca.2013.07.033. Epub 2013 Sep 5. PMID: 24012653.
Marshall WJ, Challand GS. Provision of interpretative comments on biochemical report forms. Ann Clin Biochem. 2000 Nov;37 ( Pt 6):758-63. https://doi.org/10.1258/0004563001900066. PMID: 11085619.
International Organization for Standardization (ISO). EN-ISO15189 - medical laboratories - requirements for quality and competence, 3rd ed. Geneva, Switzerland: ISO; 2012. Available from: https://www.iso.org/standard/56115.html.
Vasikaran S. Interpretative commenting. Clin Biochem Rev. 2008 Aug;29 Suppl 1(Suppl 1):S99-S103. PMID: 18852867; PMCID: PMC2556593.
Hallworth MJ. The '70% claim': what is the evidence base? Ann Clin Biochem. 2011 Nov;48(Pt 6):487-8. https://doi.org/10.1258/acb.2011.011177. PMID: 22045648.
Plebani M. Interpretative commenting: a tool for improving the laboratory-clinical interface. Clin Chim Acta. 2009 Jun;404(1):46-51. https://doi.org/10.1016/j.cca.2009.03.012. Epub 2009 Mar 17. PMID: 19298798.
Graber ML, Franklin N, Gordon R. Diagnostic error in internal medicine. Arch Intern Med. 2005 Jul 11;165(13):1493-9. https://doi.org/10.1001/archinte.165.13.1493. PMID: 16009864.
Barlow IM. Are biochemistry interpretative comments helpful? Results of a general practitioner and nurse practitioner survey. Ann Clin Biochem. 2008 Jan;45(Pt 1):88-90. https://doi.org/10.1258/acb.2007.007134. PMID: 18275680.
Piva E, Plebani M. Interpretative reports and critical values. Clin Chim Acta. 2009 Jun;404(1):52-8.https://doi.org/10.1016/j.cca.2009.03.028. Epub 2009 Mar 21. PMID: 19306860.
Reeve JL, Twomey PJ, Borovickova I. The role of the Clinical Chemistry laboratory in facilitating earlier diagnosis of dyslipidaemia-associated inherited metabolic disease. J Clin Pathol. 2020 Jul;73(7):363-365. https://doi.org/10.1136/jclinpath-2019-206254. Epub 2020 May 20. PMID: 32434768.
The Royal College of Pathologists. Guidelines for the provision of interpretative comments on biochemical reports. Bull R Coll Pathol. 1998;104:25.
Clinical Pathology Accreditation (UK) Ltd. Standards for the Medical Laboratory. [(Accessed 26 February 2008)]. http://www.cpa-k.co.uk/files/pdlabst.pdf?bcsi_scan_276FAA45874D151E=0&bcsi_scan_filename=pdlabst.pdf
Challand G, Osypiw J. Interpretation in clinical biochemistry: an external quality assurance scheme. EJIFCC. 2004 Jun 17;15(2):35-38. PMID: 30002611; PMCID: PMC6037864.
Vasikaran SD. Anatomy and history of an external quality assessment program for interpretative comments in clinical biochemistry. Clin Biochem. 2015 May; 48(7-8):467-71. https://doi.org/10.1016/j.clinbiochem.2014.12.014. Epub 2014 Dec 24. PMID: 25543064.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.