Sometimes we can process a wound swab from start to finish without ever knowing why it has been taken. It could literally be anything from a “burst pimple”, to a burns patient with a severely infected skin graft.
Insisting on clinical details goes some way to solving this problem, but even then, the details provided may not accurately convey the type or severity of the infection.
Wouldn’t it be great if we had each patient right in front of us whilst processing the wound swab? Obviously this is not practical. However if we could view a photographic image of the infection, it would immediately contextualise the wound swab that we are processing.
With the current advances in electronic requesting, such a facility is not out of the question. Dermatologists use a lot of digital imaging these days. So why not microbiologists?
Pictures are often better than words…
And when validating the report, I could then have even more information at hand:- The result, the Kiestra digital plate images, the request form and a digital image of the infection site on the patient.
Quality assurance by using all the evidence.
… And requestors might also think twice about sending in swabs of burst pimples if they also needed to provide a picture of the infection as well!
I remember as a junior doctor wading through piles (it was all paper in those days) of urine and wound swab results etc as part of my morning duties. Often the patient was not known to me, or due to the time taken for the result to come back I had forgotten what the reason was for ordering it in the first place. This makes interpretation very difficult. In essence you are to some extent managing the result, not the patient.
I am sure this still happens these days, and probably a lot more often than you would think.
The answer of course, is not only to make clinical details a pre-requisite on request forms (my mission to achieve this at my own labs is progressing slowly but surely) but also to present on the result whatever clinical details that were written on the original request form.
In this way the clinician can be reminded of the reason for requesting the test in the first place and can therefore interpret the result more accurately within the clinical context.
If clinical details are on a paper request form then it is time consuming to transcribe all these into the LIS, not to mention they may not always be legible. So I think there is an excuse for people/labs who currently use paper forms.
However once electronic requesting becomes established, there is no excuse….
CT scan results at my local hospital are reported in this fashion, always with the clinical details/reason for imaging at the start of the result report. Sadly, by looking at CT scan results, is often how I get some clinical details to help interpret microbiology results.
It is vital that the vision for microbiology follows along the same lines as CT reporting, presenting the clinical details as part of the result.
No one gives a second thought to the microbiology (or laboratory) request form when we are reviewing all our processes, and looking for efficiency and quality improvements.
However the humble request form and how it is structured is an extremely important factor with regards to influencing both the quality and quantity of test ordering.
If you have a request form with dozens of tick boxes present, each one representing a different test, you are making it very easy for the laboratory user to request a lot of tests, many of which may be either unnecessary or inappropriate.
On the other hand, if your request form is essentially a blank sheet of paper on which microbiological tests need to be pro-actively documented, it encourages test requesting only where a clear rationale exists. The downside of this approach is that the requestor may forget to include a test that should really have been done because it wasn’t visible on the form to trigger his/her memory.
There is no correct answer of course to what is the best way to structure a request form.However my personal preference is for the blank page approach, because it encourages the requestor to think carefully about what they are requesting, and to focus on the problem at hand.
However I suspect that as electronic requesting becomes more common so too will tick box request forms, as this style very much suits electronic requesting and the necessity to “code” the test requests (Thus the importance of making clinical details a pre-requisite for completing an electronic request).
Next time you see a microbiology/laboratory request form in your area, look at it carefully to see how it is structured. Is it a “Tick box” form or a “Blank Page”?