Every medical professional aims to provide the highest quality patient care possible, but we may not always agree on what that means. Laboratory professionals are often asked to test specimens that are of questionable quality, are not supported by the method validation, and/or do not have appropriate reference intervals.
While some providers want to follow a testing approach aligned with Nike’s advice to “Just Do It,” the laboratory’s response may sound more like Nancy Reagan’s “Just Say No” campaign.
The ADLM 2024 Monday morning session, “Is Bad Testing Better Than No Testing?” used three real-world situations to explore whether and when a “bad” test result may be better than no result at all. Following a brief overview of each clinical case by the moderator, Steven Cotten, PhD, DABCC, NRCC, FADLM, the audience was polled on whether they would or would not approve testing.
Cotten then moderated a lively debate between Sarah Hackenmueller, PhD, DABCC, FADLM, and Yachana Kataria, PhD, DABCC, on their reasoning to approve or deny testing for each scenario. After hearing the well-thought-out points from Kataria and Hackenmueller, video clips were shared that provided great insights into how to interpret results from the perspective of actual treatment teams, along with the potential impact of releasing or withholding “bad” results for the provider and patient.
After listening to the debates and watching the video clips, the audience was again polled to see how many would stick by their original decisions.
The cases highlighted three types of inflection points for deciding whether to release test results: the use of non-standard specimen types, poor quality specimens, and sample types without a defined reference interval.
In one case, Kataria and Hackenmueller exchanged viewpoints on accepting a highly icteric sample for ammonia testing from a patient in liver failure. They touched on concerns about going against standard operating procedures as well as the potential lack of alternate testing options in this scenario. After listening to the points raised by Kataria and Hackenmueller and watching a recorded video interview with Hersh Shroff, MD, a practicing physician, 56% of the audience kept their original decisions, 37% changed their minds, and 8% still didn’t know what to do.
The other two cases fostered similar discussions that weighed concerns about regulatory issues and setting precedents against the potential benefit for the patient and the ability to provide any kind of information when options are limited.
The robust discussion by Kataria and Hackenmuller, as well as the video clips, highlighted how the practice of quality laboratory medicine is quite nuanced, with gray areas that require judgment and an understanding of clinical needs that extends beyond analytical performance. Their back-and-forth debate clearly illustrated how the decision to provide “bad results” must take into account concerns of testing quality, physician needs, individualized patient care, and regulatory requirements.
Clinical laboratorians are often pressured by other healthcare professionals to report a result they don’t have a high degree of confidence in. Faced with this continued challenge, upcoming changes to the regulatory landscape, and increased scrutiny on laboratory testing, attendees left this session equipped with the strategies they needed to evaluate testing requests at their own institutions.
They also gleaned insight into how to participate in open and productive discussions with other healthcare professionals about finding an approach that meets providers’ needs while prioritizing patient care.
