Molinaro Ross, McCudden Christopher R., Bonhomme Marjorie, Saenger Amy (Eds.). Clinical Core Laboratory Testing

Springer, 2017. — 115 p. — ISBN: 978-1-4899-7792-2.The clinical laboratory provides a vital service and significantly contributes to patient care. It is commonly cited that ~70 % of medical decisions are based on data and interpretive information generated from the laboratory. While this number may be slightly inflated, it is well accepted that a predominant number of critical decisions made by physicians on a daily basis are centered on laboratory test results. Clinical laboratories have been transformed over the past 20 years from being slow and manual to highly automated, high-throughput production-type environments. At the same time, the amount of hands-on experience and time physicians spend in the lab has decreased dramatically. While physicians once played an active role in actually testing patient samples, it is now common for clinicians to never set foot in the laboratory. This disconnect has occurred at a time where the volume and complexity of information generated by the laboratory has grown exponentially. Comprehensive medical student and resident education regarding operation and function of the clinical laboratory is limited and often overlooked due to time limitations of the trainees, who are also attempting to learn many areas of medicine. Furthermore, the amount of material bombarding care providers at all stages in their careers (medical student, resident, fellow, or practicing physician) is immense, and leaves little time to devote to learning the intricacies of laboratory medicine, despite the fact there is heavy reliance on laboratory results to effectively treat patients. Due to the growing complexity of diagnostic testing, it is important that care providers develop a better understanding of how the laboratory works. This will ultimately lead to improved laboratory service and patient care, better communication between medical disciplines, value-added improvements in test utilization, and ultimately a reduction in healthcare costs. The patient is also an integral part of care decisions and often assumes an active role in educating themselves and acting as an effective advocate. Patients may benefit from having a more comprehensive understanding of how the laboratory works to answer questions such as “What does a given lab result tell you?” “What does a ‘laboratory error’ really mean?” “Is the lab anything like how it appears on television?” The intent of this book is to dispel some common myths about the clinical laboratory and provide tangible, practical information that can help physicians and other medical providers utilize the laboratory more effectively. It is also intended to foster appreciation for the laboratory amongst healthcare providers, advocates, and patients so they can seek expertise from the laboratory when questions arise. Early chapters focus on the structure and function of the clinical laboratory. The organization and scope of services that a laboratory provides depend heavily on the size of the lab. Labs can range in size from small/limited service physician office testing which may have one person drawing blood, collecting urine samples, and performing the testing to large national reference laboratories with dedicated aircraft available to deliver samples throughout the country or around the world. In between these two extremes lies the prototypical tertiary care center hospital laboratory at an academic medical center where both physicians and laboratory staff are trained and educated. Regardless of the size of the laboratory, there are frequently subspecialties and areas of expertise and different operational structures/leadership may exist within the laboratory. Knowledge of who has expertise in a various area can help focus problem solving and make communication more effective. As one may not seek care from a neurologist for a broken leg, one should not necessarily seek out a microbiologist for interpretation of cardiac marker results. Hospital laboratories often have separate testing areas for immunology, microbiology, cytology, hematology, biochemistry, and genetics (collectively termed “clinical pathology”). Clinical pathology operates completely differently than the area of pathology which interprets tissue specimens, termed anatomic pathology. Thus an appreciation for the scope of laboratory testing helps facilitate effective communication, realistic expectations for how long it takes to perform a certain test and if a given test can even be ordered. Should one expect a family practice clinic to provide rare genetic testing on site? Regulatory requirements follow the complexity of the laboratory and must be met in order to legally operate the laboratory and bill for services. The early chapters in this book also provide a concise outline of the scope, structure, and regulatory requirements that laboratorians face. In addition, discussion will focus around the general organizational hierarchy of the laboratory, which helps determine who should be consulted depending on the nature of the question or problem. It is a common perception that hospital laboratories look and operate like a scene out of the TV show “CSI.” The illusion of translucent computer screens and complete genome results in less than 5 min make for a satisfying story to a large audience, but, while these science fiction depictions of laboratory operations may become truth in the years to come, they have successfully intrigued the public and increased interest and awareness about different types of laboratories. The clinical laboratory, however, has not yet achieved that level of transparency, which can lead to false information and expectations from physicians and patients. The later chapters of this handbook focus on the role laboratories play in patient care by advocating for proper utilization through test ordering and result interpretation. These chapters will discuss what can go wrong in the lab testing process, and more importantly, some details of the where, when, and why of how it happens. Collectively, the objective of this book is to help those who rely on laboratory results to maximize the utility of laboratory services.