Common Post-Analytical Mistakes and Ways to Solve Them by Dr. Gaur

Dr Ravi Gaur, MD Pathology Principal Advisor, Spice Health, Ex-Director & Chair Medical Advisory Committee, Oncquest laboratories Ltd, shares his expertise about the mistakes that often take place in the post-analytical phase affecting timely reporting & quality of testing.

Dr. Ravi Gaur

Dr. Ravi Gaur

CrelioHealth for Diagnostics (formerly LiveHealth)
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The post-analytic phase is the final phase of the laboratory testing process. This phase culminates in the production of a final value, report interpretation, report approval, conclusive diagnosis, followed by sample archival including disposal and other tasks.

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Just a little oversight can lead to many mistakes, which in turn can be of grave consequences. However, when we have enough knowledge about what should be done to prevent these things from going wrong, it can help a lab grow in multiple ways.


Why we are targeting the Post-analytical Stage?

In the post-analytical phase, correct & timely delivery of reports and critical alert communication is very important. Defining critical alerts is a crucial part of the SOPs of every lab. It’s very important to do the assessment of the significance of results in the context of established reference values and decisions for further tests.

It should be established for all life-threatening conditions requiring rapid clinical intervention e.g. haemoglobin concentration, platelet count, prothrombin time and much more.

Good laboratory practise includes speedy notification to the responsible clinical staff of a result that shows an apparently unexpected serious abnormality. Most hospitals rely on manual transport of result sheets and this can significantly prolong report communication.

Computer-assisted reporting of results to linked monitors, handheld devices and printers etc near to the patient is very helpful in transmitting the final report without unreasonable delay to the desired location.


Solutions that can help at Report Approval

When we approve a patient’s report, it is advisable not to approve one value in isolation. We should correlate with all other test values of the patient. Report approval in isolation can lead to incorrect clinical interpretation at times. This is where your laboratory software (LIMS) can be extremely useful wherein all abnormal values are highlighted and linked to give a better clinical direction.

For example, if you are authenticating Serum creatinine, albumin and cholesterol. If you find, low albumin-high cholesterol-normal creatinine, and authenticate them in isolation, you will probably give multiple clinical diagnoses. But if all three are read and authenticated together, then you will be able to give a better diagnosis i.e. suggestive of Nephrotic syndrome.

Highlighted abnormal values get an immediate and better focus and interpretation.

Reflux testing is crucial and enables labs for value-added benefits like what more tests are advisable, from an existing sample. No fresh sample may be needed and can save crucial time too. A Lab Information System (LIS), which offers data on clinical correlation and reflux testing has now become a necessity.


How to use post-analytical data to improve performance, efficiency and reduce errors-

  • Critical range alerts at the time of authentication
  • For effective correlation at diagnosis and reflux testing
  • Report delivery alerts - Timely delivery of reports to the correct person is an important post-analytical function. A delayed report or missed report communication, can lead to serious errors and cost a life. Thus report delivery should be communicated back to the labs through alerts. This enables labs to know if reports are successfully delivered and reached patients and clinicians.
  • Sample archival (storage of samples after testing)- Sample archival is done to perform additional testing or learning purposes. Some samples can be stored for 2 to 7 days while some like for molecular, genetics etc can be stored for years. Having data for molecular testing helps in R&D, development of new assays etc. Thus keeping track of archived samples should be an important part of every lab. A good LIMS can take care of this very efficiently.
  • Sample disposal of hazardous material -Many labs are unaware of how to deal with biomedical waste. As a process, waste has to be barcoded and labs must make a record of it. For these matters, a LIMS must provide such data or else labs will have to buy separate software to manage biomedical waste which is an important lab function.
  • How and when to discard a tissue sample is also an important lab function of any surgical pathology lab. Having it as a LIMS function can help the lab in a big way.

Apart from these, inventory assessment, quality reviews, artificial intelligence and machine learning etc can be extremely helpful in identifying diseases, planning the next steps of diagnosis, & course of action and new testing. We will be learning about this in our future blogs.