Communication Of Laboratory Findings

To fulfill their professional obligation to the patient, microbiologists must communicate their findings to those health care professionals responsible for treating the patient. This task is not as easy as it may seem. This is nicely illustrated in a study in which a group of •physicians was asked whether they would treat a patient with a sore throat given two separate laboratory reports, that is, one that stated, "many group A Streptococcus" and one that stated, "few group A Streptococcus Although group A Streptococcus (Streptococcus pyogenes) is considered significant in any numbers in a symptomatic individual, the physicians said that they would treat the patient with many organisms but not the one with few organisms. Thus, although a pathogen (group A Streptococcus) was isolated in both cases, one word on the report (either "many" or "few") made a difference in how the patient would be handled.

In communicating with the physician, the microbiologist can avoid confusion and misunderstanding by not using jargon or abbreviations and by providing reports with clear-cut conclusions. The microbiologist should not assume that the clinician is fully familiar with laboratory procedures or the latest microbial taxonomic schemes. Thus, when appropriate, interpretive statements should be included in the written report along with the specific results. One such example would be the addition of a statement, such as "suggests contamination at collection," when more than three organisms are isolated from a clean-voided midstream urine specimen.

Laboratory newsletters should be used to provide physicians with material such as details of new procedures, nomenclature changes, and changes in usual antimicrobial susceptibility patterns of frequently isolated organisms. This last information, discussed in more detail in Chapter 12 is very'useful to clinicians when selecting empiric therapy. Empiric therapy is based on the physician determining the most likely.organ-ism causing a patient's clinical symptoms and then selecting an antimicrobial that, in the past, has worked against that organism in a particular hospital or geographic area. Empiric therapy is used to start patients on treatment before the results of the patient's culture are known and may be critical to the patient's well-being in cases of life-threatening illnesses.

Positive findings should be telephoned to the clinician, and all verbal reports should be followed by written confirmation of results. Results should be legibly handwritten or generated electronically in the laboratory information system (LIS),

CRITICAL (PANIC) VALUES

Certain critical results must be communicated to the clinician immediately. Each clinical microbiology laboratory, in consultation with its medical staff, should prepare a list of these so-called panic values. Common panic values include:

  • Positive blood cultures
  • Positive spinal fluid Gram stain or culture
  • Streptococcus pyogenes (group A Streptococcus) in a surgical wound
  • Gram stain suggestive of gas gangrene (large box-car shaped gram-positive rods)
  • Blood smear positive for malaria
  • Positive cryptococcal antigen test
  • Positive acid-fast stain
  • Detection of a significant pathogen (e.g., Legionella, Brucella, vancomycin-resistant Staphylococcus aureus).

EXPEDITING RESULTS REPORTING— COMPUTERIZATION

Before widespread computerization of clinical microbiology laboratories, result reporting was accomplished by handwriting reports and having couriers deliver hard copies that were pasted into the patient's chart. Today, microbiology computer software is available that simplifies and speeds up this task.

CPUs (central processing units), disks, tape drives, controllers, printers, video terminals, communication ports, modems, and other types of hardware support running the software. The hardware and software together make up the complete IIS. Many US systems are, in turn, hooked up with a hospital information system (HIS). Between the HIS and LIS, most functions involved in ordering and reporting laboratory tests can be handled electronically. Order entry, patient identification, and specimen identification can be handled using the same type of bar coding that is commonly used in supermarkets. The LIS also takes care of results reporting and supervisory verification of results, stores quality control data, allows easy test inquiries, and assists in test management reporting by storing, for example, the number of positive, negative, and unsatisfactory specimens. Most large systems also are capable of interfacing (communicating) with microbiology instruments to automatically download (transfer) and store data regarding positive cultures or antimicrobial susceptibility results. Results of individual organism antibiograms (patterns) can then be retrieved monthly so hospital-wide susceptibility patterns can be studied for emergence of resistant organisms or other epidemiologic information. Many vendors of laboratory information systems are now writing software for microbiology to adapt to personal computers (PCs) so that large CPUs may no longer be needed. This brings down the cost of microbiology systems so that even smaller laboratories are able to afford them. Today, small systems can be interfaced with printers or electronic facsimile machines (faxes) for quick and easy reporting and information retrieval. This further improves the quality of patient care.

Lee A and McLean S: The laboratory report: a problem in communication between clinician and microbiologist? Med JAust2:858, 1977.

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