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Ensuring successful medical laboratory / clinician interaction

With clinicians facing increasingly complex medical problems and an everexpanding range of diagnostic tests , it is vital that the laboratory and clinical staff work collaboratively to improve outcomes for patients .
Béatrice Grabein MD University Hospital Munich , Munich , Germany
Medical laboratory services are a vital part of modern-day health care , offering essential information to help guide clinical decision making in most aspects of care . In short , the input from clinical laboratories represents an integral component of modern medicine . In order for clinical staff to fully appreciate how laboratories can support them , effective communication between both parties is essential to fully benefit from their respective expertise and experience .
Modern hospital laboratories offer a wide range of services that provide the data required by physicians for patient screening , diagnosis , prognosis , treatment selection , monitoring of disease progression and / or response to treatment . Additionally , laboratory testing provides an invaluable aid to assess whether a patient needs to be hospitalised or discharged . Furthermore , clinical microbiology tests play an important role in determining , for example , if and how antibiotics are used in the hospital setting .
Of course , prior to ordering such tests , it is still necessary that clinicians assimilate all the information available and assess the relative importance of each piece of data . The decision to order a diagnostic test should be initially , and carefully , guided by the patient ’ s clinical examination , recognition of the clinical syndrome and , finally , by considering the likelihood of the condition for which the test is being ordered . This helps ensure that the right test is ordered for the right patient , at the right time .
Better communication between laboratories and clinicians serves as an important means of enhancing the clinicians ’ understanding of the value and reliability of the diagnostic tests , and ultimately how these are able to improve patient care . This becomes all the more relevant as research indicates that both primary and secondary care physicians often face challenges with diagnostic laboratory testing . In a survey of 1768 physicians in the US , although they ordered diagnostic tests for an average of 31.4 % of patient encounters every week , 14.7 % reported uncertainty about ordering a test and 8.3 % were uncertain about the interpretation of the test results . 1 In a recent study among hospitalised patients in the Netherlands , it was found that over-ordering laboratory tests was common , with the main causes being lack of awareness and knowledge about adequate testing , as well lack of confidence . 2
Clinicians are effectively the ‘ gatekeepers ’ of healthcare and ultimately responsible for requesting medical tests and making a diagnosis , so it is important that they have a complete understanding of the tests available , when these should be used , and how to interpret the results . Various technological advancements involving laboratory testing that have improved clinical decision making and patient care are described below .
Importance of the right test for the right patient , at the right time Antimicrobial stewardship From a practical perspective , when facing a suspected infection , a clinician needs to know :
• Whether or not a patient has an infection ;
• Which pathogen is responsible for that infection ;
• What is the most appropriate treatment for the infective organism .
Recent advances in diagnostic technologies have allowed the clinical laboratory to provide answers to these key questions much faster than before , but rapid results are only valuable if they can be acted upon . Antimicrobial stewardship ( AMS ) is a key area where a close interaction between microbiologists in the laboratory and hospital pharmacists and clinicians is essential to ensure adequate therapy , improved patient outcomes , and cost-efficiency . It consists of a series of measures designed to promote the optimal use of antimicrobials while minimising adverse patient outcomes .
A delay in the implementation of the appropriate antimicrobial therapy among hospitalised patients is known to result in worse clinical and economic outcomes , suggesting that