“The devil is in the (clinical) details”

Lack of clinical details on the request forms must affect thousands of microbiology laboratories worldwide.

"Very high temperature, query cause?"
“Very high temperature, query cause?”

Clinical details are important for the following reasons along with a few examples, of which there are many more:

  • In deciding what different tests to carry out on the sample. Particularly important in enteric samples, where travel history and duration of symptoms can lead to more efficient testing.
  • In deciding what antimicrobial susceptibilities to report. For example if the patient is pregnant, has a history of antibiotic allergy, has a history of an MDRO etc.
  • It also ensures that the requestor has thought about why he/she is ordering the test. If the requestor understands why they are ordering the test, it is likely to make inappropriate ordering less likely in the future.

As mentioned before, I think the introduction of electronic ordering will alleviate this problem to some extent. With electronic ordering one can simply prevent the request being completed unless some clinical details are submitted.

Laboratories have traditionally taken a very passive approach to this problem, processing everything that arrives at reception. I think this will change with time, as laboratories gradually become their own gatekeepers and the technologies to facilitate this come into play.

I would love to one day be part of a laboratory set-up where short but pertinent clinical details are mandatory on the request form for a microbiological sample.

I would not be looking for an essay, just a rationale for the test and any other pertinent clinical details as necessary….

I am interested in whether anyone else makes clinical details mandatory for microbiology samples, and what their experiences are of this?


p.s. You may be interested in this website on pharmaceutical microbiology. http://www.pharmamicroresources.com/

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