We spoke with our GP's about this a number of years ago, to try to see exactly what use they were making of the data we were sending back to them electronically.
Basically, most GP IT systems allow for the results to be filtered based on the Hi/Lo flags, they do not have the capability within them to look at the result and compare it to the reference range which is also sent out, but held as an alpha string. For this reason, we agreed that our abnormal flagging would be on the ref. range values.
The majority of GP's admitted that for a lot of the work, the requests are made by practice nurses, who can file "normal" results without any GP having to see them, but if there is an abnormal flag, then it has to be seen and filed by a GP. They felt that there would not be an increase in repeats based on marginally raised results, unless there were sound clinical reasons.
So I think that before you do make any changes, find out what use your users are making of the data you are currently sending out, because if you don't then you will get a lot of unhappy people ringing you to complain, as we did when we got the algorithm for eGFR flagging wrong, and it was calling a result of 59 or 60 normal.
Gary Mascall
Consultant in Clinical Biochemistry
Worcestershire Acute Hospitals NHS Trust
Tel: 01562 823424 extn 56100
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of David Wright
Sent: 05 March 2010 00:23
To: [log in to unmask]
Subject: Flagging abnormal results
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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Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
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