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Chapter 24 : Principles of Preanalytic and Postanalytic Test Management

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Abstract:

This chapter deals with the principles of selection, assessment, and incorporation of diagnostic tests. It reviews principles of test evaluation and utilization and their effect on patient outcomes, and describes major elements of requisition and test menu formats. The chapter also reviews principles of formatting reports of test results and the need for record storage. After careful test selection and implementation, the laboratory should evaluate both test utilization and appropriateness of test ordering to best affect cost containment and to achieve the most positive effect on patient outcomes. The preanalytic phase refers to all steps taken before actual testing is performed on a patient’s specimen. It includes the ordering of tests, collection, transportation, handling, storage, and/or referral of specimens, and assessment of all preanalytic activities. Verification includes evaluation of the performance of a new or modified test being introduced into the laboratory. Billing information required would depend on the way the client has the account set up with the laboratory. Laboratories often print the most common tests and their test codes in the test-request section of the requisition for user convenience. Medicare will cover this testing when the diagnosis code(s) provided supports the necessity requirements. The postanalytic phase refers to all steps taken after actual testing is performed on a patient’s specimen. A procedure should be in place for their retention based on the most stringent regulatory requirements for the individual laboratory. The clinical laboratory has an expanding role in today’s healthcare setting.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24

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Figure 24.1

An example of information and instructions in a laboratory users' manual for collection and submission of specimens for evaluation of whooping cough.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
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Figure 24.2

Sample of a hard-copy requisition.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
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References

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1. Bailey, M. K.,, L. Blacklidge,, C. M. Day,, L. S. Garcia,, D. Parks,, and T. Street. 1994. Keep tests in or send them out? Med. Lab. Obs. 26: 46 47.
2. Bailey, M. K.,, L. Blacklidge,, C. M. Day,, L. S. Garcia,, D. Parks,, and T. Street. 1995. How to curb physicians’ excessive testing. Med. Lab. Obs. 27: 69.
3. Barenfanger, J. 2001. Clinical microbiology laboratories can directly benefit patients. ASM News 67: 71 77.
4. Barenfanger, J.,, M. A. Short,, and A. A. Groesch. 2001. Improved antimicrobial interventions have benefits. J. Clin. Microbiol. 39: 2823 2828.
5. Baron, E. J. 1996. Development in laboratory informatics. Clin. Microbiol. Newsl. 18: 65 70.
6. Bissell, M. G., 2000. Introduction: what’s in a laboratory outcome?, p. 3 10. In M. G. Bissell (ed.), Laboratory-Related Measures of Patient Outcomes: an Introduction. American Association for Clinical Chemistry Press, Washington, D.C..
7. Cannon, B.,, and M. Lee. 1996. Clinical laboratory tests: application to daily practice. J. Am. Pharm. Assoc. NS 36: 668 679.
8. Chassin, M. R. 1996. Quality of healthcare part 3: improving the quality of care. N. Engl. J. Med. 335: 1060 1062.
9.College of American Pathologists. 2002. Education: CAP Patient Outcome Templates. [Online.] http://www.cap.org/html/member/ secure/education/pot/outcome.cfm. (Accessed 9/24/02.)
10. DeKay, M. L.,, and D. A. Asch. 1998. Is the defensive use of diagnostic tests good for patients, or bad? Med. Decis. Making 18: 19 27.
11.Department of Health and Human Services. 2003. Medicare, Medicaid and CLIA programs: laboratory requirements relating to quality systems and certain personnel qualifications. Fed. Regist. 68: 36393371.
12. Elder, B. L.,, S. A. Hansen,, J. A. Kellogg,, F. J. Marsik,, and R. J. Zabransky,. 1997. Cumitech 31, Verification and Validation of Procedures in the Clinical Microbiology Laboratory. Coordinating ed., B.W. McCurdy. ASM Press, Washington, D.C..
13. Epstein, A. M.,, and B. J. McNeil. 1986. Relationship of beliefs and behavior in test ordering. Am. J. Med. 80: 865 870.
14. Fischbach, F. 2000. A Manual of Laboratory and Diagnostic Tests, 6th ed., p. 1 33. Lippincott Williams & Wilkins, Philadelphia, Pa..
15. Garcia, L. S.,, G. W. Procop,, G. D. Roberts,, and R. B. Thomson,. 1998. Selection of diagnostic tests, p. 60 63. In B. A. Forbes,, D. F. Sahm,, and A. S. Weissfeld (ed.), Bailey & Scott’s Diagnostic Microbiology. Mosby, Inc., St. Louis, Mo..
16. Gums, J. G.,, R.W. Yancey, Jr., C. A. Hamilton, and P. S. Kubilis. 1999. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team. Pharmacotherapy 19: 1369 1377.
17. Halsey, J. F. 2000. Direct access testing in the clinical laboratory: should laboratories offer testing services directly to the consumer? Clin. Leadersh. Manag. Rev. 14: 261 266.
18. Hawkins, H. H.,, R.W. Hankins,, and E. Johnson. 1999. A computerized physician order entry system for the promotion of ordering compliance and appropriate test utilization. J. Healthc. Inf. Manag. 13: 63 72.
19.. Health Care Financing Administration. 1992. Medicare, Medicaid, and CLIA programs. Regulations implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Fed. Regist. 57: 70027186.
20. Heffner, D. K.,, and C. F. Adair. 1999. Clarity on the diagnosis line (the devil is in the details). Ann. Diagn. Pathol. 3: 187 191.
21. Howanitz, J. H.,, and P. J. Howanitz,. 1991. Principles of laboratory medicine, p. 1 10. In J. H. Howanitz, and P. J. Howanitz (ed.), Laboratory Medicine: Test Selection and Interpretation. Churchill Livingston Inc., New York, N.Y..
22. Jacobs, I. A.,, K. Kelly,, C. Valenziano,, A. H. Chevinsky,, J. Pawar,, and C. Jones. 2000. Cost savings associated with changes in routine laboratory tests ordered for victims of trauma. Am. Surg. 66: 579 584.
23.Joint Commission on Accreditation of Healthcare Organizations. 1990. Accreditation Manual of Hospitals, p. 137138. Joint Commission on Accreditation of Healthcare Organizations, Chicago, Ill..
24.Joint Commission on Accreditation of Healthcare Organizations. 1996. Comprehensive Accreditation Manual for Pathology and Laboratory Services. Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Ill..
25. Kazmierczak, S. C. 1999. Statistical techniques for evaluating the diagnostic utility of laboratory tests. Clin. Chem. Lab. Med. 37: 1001 1009.
26. Kilgore, M.,, L. Hensley,, C. Howard,, J. Craft,, and J. A. Smith. 1999. Curbing overutilization: the silver lining to HCFA compliance. Med. Lab. Obs. 31: 26 28.
27. Kollef, M. H.,, and S. Ward. 1998. The influence of mini-BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia. Chest 113: 412 420.
28. Labeau, K. M.,, M. Simon,, and S. J. Steindel. Clinical laboratory test menu changes in the Pacific Northwest: an evaluation of the dynamics of change. Clin. Leadersh. Manag. Rev. 15: 16 22.
29. LaRocco, M. 1995. Quality and productivity in the microbiology laboratory: continuous quality improvement. Clin. Microbiol. Newsl. 17: 129 131.
30. Lewandrowski, K.,, and D. MacMillan. 2003. Selection of a clinical reference laboratory: general principles and some observations from Massachusetts General Hospital. Clin. Microbiol. Newsl. 25: 33 37.
31. Linehan, B. J.,, M. M. El-Nageh,, S. Cordner,, and A. Richter,. 2002. Ethics in laboratory medicine, p. 134 142. In K. D. McClatchey (ed.), Clinical Laboratory Medicine, 2nd ed. Lippincott Williams & Wilkins, Philadelphia, Pa..
32. Lundberg, G.D. 1999. How clinicians should use the diagnostic laboratory in a changing medical world. Clin. Chem. Acta 280: 3 11.
33. Marcon, M. J. 2003. “Value-added” reporting in clinical microbiology: using computer-based textual reports and comments as an aid to communicating appropriate utilization and application of test results. Clin. Microbiol. Newsl. 25: 25 31.
34. Mayer, M. 1991. Unnecessary laboratory tests in diagnosis and treatment. Harefuah 120: 66 69.
35.NCCLS. 1998. Basic Cost Accounting for Clinical Services; Approved Guideline. NCCLS document GP11-A. NCCLS, Wayne, Pa..
36.NCCLS. 2003. Application of a Quality System Model for Laboratory Services; Approved Guideline, 2nd ed. NCCLS document GP26-A2. NCCLS, Wayne, Pa..
37. Nicoll, C. D.,, and M. Pignone,. 2002. Diagnostic testing and medical decision making, p. 1669 1680. In L. M. Tierney, Jr.,, S. J. McPhee,, and M. A. Papadakis (ed.), 2002 Current Medical Diagnosis & Treatment, 41st ed. Lange Medical Books/McGraw Hill, New York, N.Y..
38. Plebani, M. 1999. The changing face of clinical laboratories. Clin. Chem. Lab. Med. 37: 711 717.
39. Rodriguez, F. 1996. Improve microbiology procedures and utilization while saving money. Med. Lab. Obs. 28: 60 64.
40. Ruangkanchanasetr, S. 1993. Laboratory investigation utilization in pediatric out-patient department Ramathibodi Hospital. J. Med. Assoc. Thai. 76(Suppl 2): 194 208.
41. Schubart, J. R.,, C. E. Fowler,, G. R. Donowitz,, and A. F. Connors, Jr. 2001. Algorithm-based decision rules to safely reduce laboratory test ordering. Medinfo 10: 523 527.
42. Sewell, D.,, and J.D. MacLowry,. 1999. Laboratory management, p. 4 22. In P. R. Murray,, E. J. Baron,, M. A. Pfaller,, F. C. Tenover,, and R. H. Yolken (ed.), Manual of Clinical Microbiology, 7th ed. ASM Press, Washington, D.C..
43. Shimetani, N. 1998. Consultation on laboratory information—from the perspectives of clinical pathologists and medical technologists. Rinsho Byori 46: 987 993.
44. Silverstein, J. C.,, and A. S. Rothschild. 1999. Clinical perspectives on the modern laboratory. Clin. Lab.Med. 19: 421 432.
45. Silverstein, M. D., 2000. Laboratory tests for case-finding and screening for disease in the ambulatory setting, p. 129 146. In M. G. Bissell (ed.), Laboratory-Related Measures of Patient Outcomes: an Introduction. American Association for Clinical Chemistry Press, Washington, D.C..
46. Southwick, K. 2002. Antibiotic alert—labs, pharmacies take on cost and misuse. CAP Today 16: 62 71.
47. Statland, B. E. 1994. Cost/benefit of screening. Med. Lab. Obs. 26: 11.
48. Studnicki, J.,, D.D. Bradham,, J. Marshburn,, P. R. Foulis,, and J.V. Straumfjord. 1993. A feedback system for reducing excessive laboratory tests. Arch. Pathol. Lab.Med. 117: 35 39.
49. Thomas, J. G. 2000. Outcomes assessment: empowerment for microbiologists. Adv. Lab. 9: 54 60.
50. Toubert, M. E.,, S. Chevret,, B. Cassinat,, M. H. Schlageter,, J. P. Beressi,, and J. D. Rain. 2000. From guidelines to hospital practice: reducing inappropriate ordering of thyroid hormone and antibody tests. Eur. J. Endocrinol. 142: 605 610.
51. Travers, E. M., 2002. Business management of the clinical laboratory, p. 49 77. In K. D. McClatchey (ed.), Clinical Laboratory Medicine, 2nd ed. Lippincott Williams & Wilkins, Philadelphia, Pa..
52. Travers, E. M.,, and K. D. McClatchey,. 2002. Basic laboratory management, p. 3 48. In K. D. McClatchey (ed.), Clinical Laboratory Medicine, 2nd ed. Lippincott Williams & Wilkins, Philadelphia, Pa..
53. Valenstein, P.,, M. Pfaller,, and M. Yungbluth. 1996. The use and abuse of routine stool microbiology: a College of American Pathologists Q-probes study of 601 institutions. Arch. Pathol. Lab. Med. 120: 206 211.
54. Winkens, R. A. G.,, P. Pop,, A. M. A. Bugter-Maessen,, R. P. T. M. Grol,, A. D. M. Kester,, G. H. M. I. Beusmans,, J. A. Knottnerus. 1995. Randomised controlled trial of routine individual feedback to improve rationality and reduce numbers of test requests. Lancet 345: 498 502.
55. Wong, E. T. 1985. Cost-effective use of laboratory tests: a joint responsibility of clinicians and laboratorians. Clin. Lab.Med. 5: 665 672.

Tables

Generic image for table
Table 24.1

Description of processes in the clinical laboratory

Compiled from references 19 and 36.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
Generic image for table
Table 24.2

Applications of laboratory tests

Adapted from references 14 and 37.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
Generic image for table
Table 24.3

Properties of useful diagnostic tests

Adapted from reference 37.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
Generic image for table
Table 24.4

Parameters for ideal characteristics for screening tests

Adapted from reference 37.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
Generic image for table
Table 24.5

Factors affecting decision to implement or discontinue a test

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
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Table 24.6

Demographic information needed on test requisition

From reference 19.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
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Table 24.7

Quality assessment of postanalytic systems should include review or evaluation of the following areas

From references 11 and 19.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
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Table 24-8

Sample list of textual “value-added” comments attached to specific laboratory reports.

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24
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Table 24.9

Example of specimen retention requirements by regulatory agency

Citation: Katsaras R, Khalsa A, Smith R, Saubolle M. 2004. Principles of Preanalytic and Postanalytic Test Management, p 417-432. In Garcia L, Baselski V, Burke M, Schwab D, Sewell D, Steele J, Weissfeld A, Wilkinson D, Winn W (ed), Clinical Laboratory Management. ASM Press, Washington, DC. doi: 10.1128/9781555817695.ch24

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