Michael Laposata - Clinical Diagnostic Tests: How to Avoid Errors in Ordering Tests and Interpreting Results

How to Avoid Errors in Ordering Tests and Interpreting Results

Edited by

Michael Laposata, MD, PhD

Professor and Chair

Department of Pathology

University of Texas Medical BranchGalveston

Galveston, Texas

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ISBN: 9781620700839

e-book ISBN: 9781617052620

Acquisitions Editor: Rich Winters

Compositor: diacriTech

2016 Demos Medical Publishing, LLC. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Medicine is an ever-changing science. Research and clinical experience are continually expanding our knowledge, in particular our understanding of proper treatment and drug therapy. The authors, editors, and publisher have made every effort to ensure that all information in this book is in accordance with the state of knowledge at the time of production of the book. Nevertheless, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the contents of the publication. Every reader should examine carefully the package inserts accompanying each drug and should carefully check whether the dosage schedules mentioned therein or the contraindications stated by the manufacturer differ from the statements made in this book. Such examination is particularly important with drugs that are either rarely used or have been newly released on the market.

Library of Congress Cataloging-in-Publication Data

Clinical diagnostic tests : how to avoid errors in ordering tests and interpreting results / editor, Michael Laposata.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-62070-083-9ISBN 978-1-61705-262-0 (ebook)

I. Laposata, Michael, editor.

[DNLM: 1. Clinical Laboratory Techniquesmethods. 2. Diagnostic Tests, Routinemethods. 3. Diagnostic Errorsprevention & control. WB 200]

RC71.2

616.07'5dc23

2015016835

Printed in the United States of America by Gasch.

14 15 16 17 / 5 4 3 2 1

Quentin G. Eichbaum, Garrett S. Booth, and Pampee P. Young

Michael Laposata

Adam C. Seegmiller and Mary Ann Thompson Arildsen

James H. Nichols and Carol A. Rauch

Charles W. Stratton

Candis A. Kinkus

Mary Ann Thompson Arildsen, MD, PhD

Department of Pathology, Microbiology and Immunology

Vanderbilt University School of Medicine

Nashville, Tennessee

Garrett S. Booth, MD, MS

Department of Pathology, Microbiology and Immunology

Vanderbilt University School of Medicine

Nashville, Tennessee

Quentin G. Eichbaum, MD, PhD, MPH, MFA, MMHC, FCAP

Department of Pathology, Microbiology and Immunology

Vanderbilt University School of Medicine

Nashville, Tennessee

Candis A. Kinkus, MBA

Diagnostic Laboratories

Vanderbilt University Medical Center

Nashville, Tennessee

Michael Laposata, MD, PhD

Department of Pathology

University of Texas Medical BranchGalveston

Galveston, Texas

James H. Nichols, PhD, DABCC, FACB

Department of Pathology, Microbiology and Immunology

Vanderbilt University School of Medicine

Nashville, Tennessee

Carol A. Rauch, MD, PhD, FCAP

Department of Pathology, Microbiology and Immunology

Vanderbilt University School of Medicine

Nashville, Tennessee

Adam C. Seegmiller, MD, PhD

Department of Pathology, Microbiology and Immunology

Vanderbilt University School of Medicine

Nashville, Tennessee

Charles W. Stratton, MD

Department of Pathology, Microbiology and Immunology

Vanderbilt University School of Medicine

Nashville, Tennessee

Pampee P. Young, MD, PhD

Department of Pathology, Microbiology and Immunology; and

Department of Medicine

Vanderbilt University School of Medicine

Nashville, Tennessee

The Institute of Medicine in the United States has recently organized a committee, of which I am a member, on diagnostic error in health care. It has become clear that major contributors to diagnostic mistakes include the incorrect selection of laboratory tests and the misinterpretation of laboratory test results. As the clinical laboratory test menu has greatly expanded in the past decade in size, complexity, and cost, the challenge of ordering the right tests, and only the right tests, and correctly interpreting complex test results, has become a significant challenge for most health care providers for a larger and larger percentage of their patients.

The idea to produce books describing medical errors related to inappropriate selection of laboratory tests and misinterpretation of laboratory test results first emerged in a discussion in a restaurant in Chicago. The first challenge was to determine whose medical errors would be reported. Would this be a compilation of medical errors reported in the literature, personally observed medical errors in the experience of an author, or admissions of unpublished mistakes by medical colleagues? Ultimately, it was decided to invite established experts in the different areas of laboratory medicine to become authors who could bring forward errors that they had read about, personally encountered, or learned from discussions with clinical and laboratory colleagues. The goal for each author was to identify and describe the most common mistakes in his or her specialty area of laboratory medicine, and then use those mistakes to create a set of standards of care that would lead to a reduction in the frequency of those errors. Six separate books were produced in the series, and they describe errors in laboratory testing for coagulation, transfusion medicine, clinical chemistry, clinical microbiology, hematology and immunology, and the often overlooked area of laboratory management. The organization of each book is similar. A major group of diagnostic errors associated with the clinical laboratory (such as those in which an abscess is mistakenly concluded to be a malignancy because of findings in the microbiology laboratory) is introduced with a brief background on that group of medical errors, followed by an actual case to illustrate this error, then a short statement that describes the clinical pitfall, and finally a list of standards of care related to, in this example, appropriate testing to minimize the number of cases mistakenly identified as abscesses that are, in fact, malignancies. After production of the last of the six books, it was recognized that removal of the case examples would allow all six books to be combined into the one clinically valuable book which follows this preface.