Tubes of blood samples for testing, medical equipment
HealthSeptember 29, 2021

Your patient receives an abnormal lab result. Now what?

While the prevalence of inappropriate testing in the U.S. is unknown, many studies point to common inefficiencies and errors which affects many diagnosis and treatment decisions. A systematic approach for lab interpretation, especially for out-of-range results, can effectively guide clinicians in determining appropriate next steps for their patients.

When a clinician orders a laboratory test, all that comes back on the report is a result and a normal reference range. If the result is outside of the normal range, there’s nothing on the lab report that explains why the result might be high, low, or abnormal, or what to do next.

If needed, clinicians will typically investigate further by referring to clinical decision support, consulting with colleagues and specialists, and they may order more tests or make referrals. While this process is standard in medical practice, there can be uncertainty in interpreting some lab tests.

For diagnosis and differential diagnosis — differentiating between two or more conditions that share similar signs or symptoms — the evidence and guidance is often not clear. In addition, the number and complexity of lab tests make it challenging to accurately order and interpret tests and abnormal results.

Other disconnects happen when clinicians cover for other clinicians’ patients, say overnight and weekends, or for different specialties. Clinicians might also order more tests when they aren’t sure of what’s going on with their patient, which isn’t good for the patient or their pocketbook.

To solve a common inefficiency, a consistent approach to lab interpretation is needed

Lab interpretation monographs are a new type of clinical content that offers a systematic approach for clinicians to judiciously proceed with treatment, referral, or follow-up testing.

In practice, a clinician would pair the patient’s symptoms, their medications, and their physical exam findings with the information in the monograph to home in on a diagnosis and determine if further testing is needed.

In some instances, a clinician may refer to the monograph and discover that they don’t need a particular test they were planning to order. For example, it’s a moving target as to what is a normal blood vitamin D level. Many clinicians think 20 or 21 is outside the normal range and may order additional tests. Checking the monograph, they’d find that 20 or over is still within an acceptable range and they don’t have to do any further testing.

On the other hand, there could be instances when a clinician reads the monograph and shifts their focus to a diagnosis they hadn’t even considered. In this case, additional testing may be required; however, the evaluation is more expeditious instead of drawn out by ordering some tests, finding they are negative, and then ordering other tests to determine a diagnosis.

With such a systematic approach to managing abnormal lab results, clinicians make more confident — and more effective — decisions for their patients. Assessing the impact of this approach on quality measures by specialties should be the next priority for health systems to deliver better, more targeted care for their populations.

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