Orders for lab work are a part of medical care in everything from a general physical at a doctor’s office to any hospitalization. While they may seem routine, they’re certainly important. According to hospital accrediting body The Joint Commission, 70% of all medical decisions are based on a lab test.
Research shows that laboratory tests are ordered more often than any other diagnostic procedure. (In case you’re curious, the next most common diagnostic workups include radiology, vital signs, respiratory, and cardiology workups). A whopping 98% of all patients admitted to a hospital have at least one lab test ordered. The same is true for 56% of patients seen in the emergency room and 29% of people seen on an outpatient basis.
While it’s clear that doctors, physician’s assistants, and nurse practitioners rely on lab data, I’ve seen a lot of instances where lab work results get bungled. That can lead to deadly outcomes.
Most hospitals have in-house laboratories to handle studies that are ordered. Other facilities, like skilled nursing facilities (SNFs) or rehabilitation centers, often send samples out to off-site labs to process the studies. Regardless of whether it’s an in-house lab or an external contract lab doing the analysis, each lab has its own set of standards for each test. These are called reference ranges.
For any type of lab work or test, the laboratory will define reference ranges including normal, high, low, critically-high, and critically-low. Some labs and facilities use the terms “alert” or “panic” values to refer to critical results. If you look at lab results in your medical records, you’ll see your actual values, as well as the lab’s reference ranges. I think it’s informative to discuss the results with your doctor and to ask questions about any abnormal reports.
The weak link
With the increasing use of electronic medical records, many laboratories report test results electronically, without any human interaction between laboratory staff and a healthcare provider. Because lab work plays such a key role in guiding diagnosis and medical decision-making, it’s important for patient safety that there’s prompt and clear communication of test results.
In my experience as a Houston, Texas medical malpractice attorney, poor laboratory communication is a weak link in healthcare.
When physicians or mid-level providers order lab work, lab personnel are required to communicate the results back to the nursing staff. In the case of critical values, it’s appropriate for lab personnel to notify the ordering provider directly.
Once the nursing staff receives notification of lab results, it’s their responsibility to inform the doctor.
But even if the lab or nursing staff drop the ball, physicians or ordering providers are still responsible for following up on their orders. It’s unacceptable just to keep waiting after an unreasonable amount of time without asking for the results.
What you can do
In a hospital setting, it’s rather difficult for a patient to keep up with all of the tests being ordered. In an outpatient office or clinic setting, though, it’s a bit more straight-forward. In these situations, you can help improve your safety as a patient by making sure you know what lab work, radiology tests, or other studies are being ordered and why they’re important. I recommend asking for a personal copy of the order, just to make sure you’re in the loop.
Once you have blood work or a sample drawn, ask when the results will be in. Then follow-up with your physician to find out the results and to get an explanation of what they mean.
Any time I think about lab communication problems, I think about a mom whom I represented in a medical malpractice case involving poor prenatal care.
The OB/GYN physician sent her to a next-door independent laboratory to have some blood work done. What my client didn’t know is that the doctor actually ordered three separate blood tests, not just one. Because the doctor electronically transmitted the orders directly to the laboratory and didn’t give the patient a paper copy of the orders, this mom had no idea that the lab didn’t perform all the tests. All she knew is that she went to the lab as instructed and that the lab techs took a blood sample.
The lab sent the results back to the physician electronically, and the electronic medical records software automatically filed them away without anyone actually reviewing the reports. The different doctors at the clinic who saw this mom during her prenatal period didn’t seem to notice that one important blood test that had been ordered was missing. Even though she was sent back to the lab for additional studies later in her pregnancy, this one test never got done.
As a result of a “failure to communicate” between the lab and the OB/GYN physician, this mom’s baby was born with a life-threatening brain injury caused by an Rh-incompatibility reaction. The baby was born severely anemic after the mom’s immune system attacked his red blood cells. He barely survived.
Sadly, this is exactly what the missing bloodwork would’ve identified. If there had been appropriate communication—or even if the doctor had kept the mom in the loop by giving her a copy of her lab orders—the baby would’ve received treatment in the womb and had a smooth, safe labor and delivery.
