I hate to add yet another stick to a well burning fire but as a physician
practicing on the wards and in the laboratory I have to be honest and say
that I  think interpretative comments are close to useless and stem from the
days when the laboratory tests were influenced by everything including the
temperature in the laboratory. After accuracy and precision TAT is the next
most important component vis-à-vis patient care. Most of the automated
results from my laboratory are automatically released, i.e. are never seen
by a laboratory technologist or Biochemist. This occurs if there is no error
messages sent across the interface and they are not in the panic value
range. I would want some serious data, not just ideologies, to change this
practice. The sooner a good result is back to a physician the better it is
for the patient. Hard as it may be for me to say it I agree with Mike Ryan

Elizabeth Mac Namara
JGH Montreal, Quebec, Canada

-----Original Message-----
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Sent: November 30, 2001 6:31 AM
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Subject: Re: Out of hours validation - responses


This 'validation debate' is fascinating. This 'add-on' type of activity
must surely be ripe for review. When a result is analytically correct,
additional validation and interpretative commenting is more often than not
merely a form of occupational therapy for senior laboratory staff rather
than a useful contribution to patient care. The information available to
the laboratory is simply insufficient to merit any definitive contribution
in many cases.

We have just received our CPA report. Our accreditation status has been
'reduced' to conditional unless our laboratroy computer system is replaced
within a year. The reason given is that interpretative reporting facilities
are limited.

Naturally, we are disappointed as we feel that the level of clinical detail
given on request forms is often insufficient to  provide an intelligent
interpretive comment. Indeed, with limited knowledge of the global state of
the patient, so-called interpretive comments based on biochemistry alone
are often unhelpful and may be downright dangerous. Indeed, this is
recognized in recent college guidelines (SAC , Chemical Pathology).The
personal interaction with clinicians is far more useful. 'Ivory tower'
interpretive comments based on little more than a 'biochemical snapshot'
undermines the credibility of clinical biochemistry and risks the dismissal
of the laboratory's contribution to patient management as mere
'interference'. Holding results for such 'validation procedures' increases
TAT, insults the intelligence of our users more often than we would like to
admit, and has little evidence base to back it up.

Has anyone ever tested the utility of interpretative comments in terms of
contribution to patient mangement rather than in terms of an internal
feelgood factor ? Has CPA overstepped the mark here? It seems the oucome of
the debate has been anticipated to the point where interpretive comments
have become an end in themselves, without due regard to their
appropriateness. Surely evidence based practice should apply to the
accreditation process as well. In the absence of evidence of any shortfall
in service to patients, should the limitations of 'interpretative comments'
facilities threaten the Accreditation of the entire service ?

Michael Ryan