Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists

Background: Clinicians view the accuracy of test results and the turnaround time as the two most important service aspects of the clinical microbiology laboratory. Because of the time needed for the culturing of infectious agents, final hardcopy culture results will often be available too late to have a significant impact on early antimicrobial therapy decisions, vital in infectious disease management. The clinical microbiologist therefore reports to the clinician clinically relevant preliminary results at any moment during the diagnostic process, mostly by telephone. Telephone reporting is error prone, however. Electronic reporting of culture results instead of reporting on paper may shorten the turnaround time and may ensure correct communication of results. The purpose of this study was to assess the impact of the implementation of electronic reporting of final microbiology results on medical decision making. Methods. In a pre- and post-interview study using a semi-structured design we asked medical specialists in our hospital about their use and appreciation of clinical microbiology results reporting before and after the implementation of an electronic reporting system. Results: Electronic reporting was highly appreciated by all interviewed clinicians. Major advantages were reduction of hardcopy handling and the possibility to review results in relation to other patient data. Use and meaning of microbiology reports differ significantly between medical specialties. Most clinicians need preliminary results for therapy decisions quickly. Therefore, after the implementation of electronic reporting, telephone consultation between clinician and microbiologist remained the key means of communication. Conclusions: Overall, electronic reporting increased the workflow efficiency of the medical specialists, but did not have an impact on their decision-making

Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus

Background: Multiple laboratory tests are used to diagnose and manage patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these tests varies substantially. Approach: An expert committee compiled evidence-based recommendations for the use of laboratory testing for patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. Draft guidelines were posted on the Internet and presented at the 2007 Arnold O. Beckman Conference. The document was modified in response to oral and written comments, and a revised draft was posted in 2010 and again modified in response to written comments. The National Academy of Clinical Biochemistry and the Evidence-Based Laboratory Medicine Committee of the American Association for Clinical Chemistry jointly reviewed the guidelines, which were accepted after revisions by the Professional Practice Committee and subsequently approved by the Executive Committee of the American Diabetes Association. Content: In addition to long-standing criteria based on measurement of plasma glucose, diabetes can be diagnosed by demonstrating increased blood hemoglobin A$_{1c}$ (HbA$_{1c}$) concentrations. Monitoring of glycemic control is performed by self-monitoring of plasma or blood glucose with meters and by laboratory analysis of HbA$_{1c}$. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. Summary: The guidelines provide specific recommendations that are based on published data or derived from expert consensus. Several analytes have minimal clinical value at present, and their measurement is not recommended

The Integration of Decision Analysis Techniques in High-Throughput Clinical Analyzers

From the early 1990s, the introduction of high-throughput clinical analyzers has significantly changed the workflow of In-Vitro-Diagnostics (IVD) tests. These high-tech instruments have helped and keep helping clinical laboratories both to increase quality diagnostic responses and to get more for every dollar they spend. Nevertheless, IVD industrial research has been up to now largely hardware-driven with the introduction in the market of many sophisticated technologies. The software component, models and decision support systems in particular, has lagged behind. To reach the full potential of diagnostic automation, it must be addressed the challenge of making the most intelligent use of the hardware that is deployed. Focusing on time efficiency, the authors have devised an operations research-based method for a class of high-throughput clinical analyzers. To demonstrate the validity of the research, the proposed method has been coded and integrated into the Laboratory Information System of the Laboratorio di Analisi Cliniche Dr. P. Pignatelli, one of the most important clinical laboratories in Southern Italy. Siemens Immulite ®; 2000 has been the reference case. The enhanced operating planning procedure provides a monetary benefit of 52,000 USD/year per instruments and a trade-off between clinical benefits and operating costs equivalent to the one provided by the current hardware-driven research at Siemens. Despite the proposed approach has the potential to determine guidelines for enhancing a wide range of current high-throughput clinical analyzers, we have to register a failure in trying to convince technology providers to invest in embedding such new models in their hardware. Some possible causes for such failure are highlighted, trying to find possible improvements for future developments