The Effect of Laboratory Test-Based Clinical Decision Support Tools on Medication Errors and Adverse Drug Events: A Laboratory Medicine Best Practices Systematic Review.

Background: Laboratory and medication data in electronic health records create opportunities for clinical decision support (CDS) tools to improve medication dosing, laboratory monitoring, and detection of side effects. This systematic review evaluates the effectiveness of such tools in preventing medication-related harm.

Methods: We followed the Laboratory Medicine Best Practice (LMBP) initiative's A-6 methodology.

Interventions to prevent iatrogenic anemia: a Laboratory Medicine Best Practices systematic review.

Background: As many as 90% of patients develop anemia by their third day in an intensive care unit (ICU). We evaluated the efficacy of interventions to reduce phlebotomy-related blood loss on the volume of blood lost, hemoglobin levels, transfusions, and incidence of anemia.

Methods: We conducted a systematic review and meta-analysis using the Laboratory Medicine Best Practices (LMBP) systematic review methods for rating study quality and assessing the body of evidence.

Identifying, Analyzing, and Visualizing Diagnostic Paths for Patients with Nonspecific Abdominal Pain.

Background: Diagnosis is complex, uncertain, and error-prone. Symptoms such as nonspecific abdominal pain are especially challenging. A diagnostic path consists of diagnostic steps taken from initial presentation until a diagnosis is obtained or the evaluation ends for other reasons.

Identifying Preanalytic and Postanalytic Laboratory Quality Gaps Using a Data Warehouse and Structured Multidisciplinary Process.

Context.—: The laboratory total testing process includes preanalytic, analytic, and postanalytic phases, but most laboratory quality improvement efforts address the analytic phase. Expanding quality improvement to preanalytic and postanalytic phases via use of medical data warehouses, repositories that include clinical, utilization, and administrative data, can improve patient care by ensuring appropriate test utilization.

Identifying Diagnostic Paths for Undifferentiated Abdominal Pain from Electronic Health Record Data.

The diagnostic process is a complex, uncertain, and highly variable process which is under-studied and lacks evidence from randomized clinical trials. This study used a novel visual analytics method to identify and visualize diagnostic paths for undifferentiated abdominal pain, by leveraging electronic health record (EHR) data of 501 patients in the ambulatory setting of a single institution. A total of 63 patients reached diagnoses in the study sample.

Identifying and analyzing diagnostic paths: a new approach for studying diagnostic practices.

Diagnostic error is a serious public health problem to which knowledge gaps and associated cognitive error contribute significantly. Identifying diagnostic approaches to common problems in ambulatory care associated with more timely and accurate diagnosis and lower cost and harm associated with diagnostic evaluation is an important priority for health care systems, clinicians, and of course patients. Unfortunately, guidance on how best to approach diagnosis in patients with common presenting complaints such as abdominal pain, dizziness, and fatigue is lacking.

Interventions to Improve Follow-Up of Laboratory Test Results Pending at Discharge: A Systematic Review.

Failure to follow up test results pending at discharge (TPAD) from hospitals or emergency departments is a major patient safety concern. The purpose of this review is to systematically evaluate the effectiveness of interventions to improve follow-up of laboratory TPAD. We conducted literature searches in PubMed, CINAHL, Cochrane, and EMBASE using search terms for relevant health care settings, transition of patient care, laboratory tests, communication, and pending or missed tests.

Current evidence and future perspectives on the effective practice of patient-centered laboratory medicine.

Background: Systematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally.

Content: This review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding.

A prospective tool for risk assessment of sendout testing.

Objective: Errors associated with laboratory testing can cause significant patient harm. Sendout testing refers to tests sent by a primary lab to a reference lab when testing is unavailable at the primary lab. Sendout testing is particularly high risk for patient harm, due to many factors including increased hand-offs, manual processes, and complexity associated with rare, low-volume tests.

Primary care physicians' challenges in ordering clinical laboratory tests and interpreting results.

Background: The number and complexity of clinical laboratory tests is rapidly expanding, presenting primary care physicians with challenges in accurately, efficiently, and safely ordering and interpreting diagnostic tests. The objective of this study was to identify challenges primary care physicians face related to diagnostic laboratory testing and solutions they believe are helpful and available to them.

Methods: In this study, sponsored by the Centers for Disease Control and Prevention, a random sample of general internal medicine and family medicine physicians from the American Medical Association Masterfile were surveyed in 2011.

Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis.

Objective: To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing.

Results: A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.

Effectiveness of automated notification and customer service call centers for timely and accurate reporting of critical values: a laboratory medicine best practices systematic review and meta-analysis.

Objective: To conduct a systematic review of the evidence available in support of automated notification methods and call centers and to acknowledge other considerations in making evidence-based recommendations for best practices in improving the timeliness and accuracy of critical value reporting.

Design And Methods: This review followed the Laboratory Medicine Best Practices (LMBP) review methods (Christenson, et al. 2011).

Laboratory medicine best practices: systematic evidence review and evaluation methods for quality improvement.

Objective: To develop methods for systematically reviewing evidence for identifying effective laboratory medicine (LM) practices associated with improved healthcare quality outcomes.

Relevance: Although many evidence-evaluation systems have been developed, none are designed to include and rate healthcare quality improvement studies to identify evidence-based practices that improve patient safety and LM quality.

Methods: Validated evidence-based medicine methods established by governmental agencies, the Guide to Community Preventive Services, and others were adapted for the LM field.

IQLM and CLMA take a snapshot of America's hospital laboratory quality management.

CLMA volunteered to conduct an online pilot survey of its membership to help the Institute for Quality in Laboratory Medicine (IQLM) determine quality management activities in laboratories. Among the hospital-based members who were surveyed, approximately 25 percent responded. The data they volunteered provide a snapshot of the current state of laboratory quality management.