We currently flag any result outside the appropriate reference interval for the
analyte. Clinicians are contacted when results are beyond agreed "phone out"
limits. Other flagged results are downloaded, electronically filtered and
presented to GP's who feel obliged to act upon them, usually by generating
repeat requests.
Laboratories are increasingly being asked to control demand. Flag limits that are
set too low may be contributing to unnecessary demand on our services. If set
too high, we fail to act in the patient's interest by notifying the clinician. The
suspicion in our case is we are creating unnecessary work and this is supported
by anecdotal evidence.
What evidence is there for setting these flag limits? How have you set about
reaching agreement between the Laboratory and clinician? Has anyone audited
the repeat analysis request following a result just outside reference intervals?
What do you employ?
1. No flags
2. The reference (2 s.d.) interval?
3. A wider clinically remarkable interval, say 3 s.d?
4. An even wider pathological interval / limit?
5. Panic result limits
Just what is best practice?
David Wright
BMS3
Biochemistry Dept
Antrim Laboratory
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