Closing the brain-to-brain loop in laboratory testing

Mario Plebani; Giuseppe Lippi

doi:10.1515/CCLM.2011.617

Article

Closing the brain-to-brain loop in laboratory testing

Mario Plebani and Giuseppe Lippi

Published/Copyright: June 13, 2011

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From the journal Clinical Chemistry and Laboratory Medicine Volume 49 Issue 7

Abstract

The delivery of laboratory services has been described 40 years ago and defined with the foremost concept of “brain-to-brain turnaround time loop”. This concept consists of several processes, including the final step which is the action undertaken on the patient based on laboratory information. Unfortunately, the need for systematic feedback to improve the value of laboratory services has been poorly understood and, even more risky, poorly applied in daily laboratory practice. Currently, major problems arise from the unavailability of consensually accepted quality specifications for the extra-analytical phase of laboratory testing. This, in turn, does not allow clinical laboratories to calculate a budget for the “patient-related total error”. The definition and use of the term “total error” refers only to the analytical phase, and should be better defined as “total analytical error” to avoid any confusion and misinterpretation. According to the hierarchical approach to classify strategies to set analytical quality specifications, the “assessment of the effect of analytical performance on specific clinical decision-making” is comprehensively at the top and therefore should be applied as much as possible to address analytical efforts towards effective goals. In addition, an increasing number of laboratories worldwide are adopting risk management strategies such as FMEA, FRACAS, LEAN and Six Sigma since these techniques allow the identification of the most critical steps in the total testing process, and to reduce the patient-related risk of error. As a matter of fact, an increasing number of laboratory professionals recognize the importance of understanding and monitoring any step in the total testing process, including the appropriateness of the test request as well as the appropriate interpretation and utilization of test results.

Keywords: brain-to-brain loop; clinical risk management; extra-analytical indicators; patient safety; quality specifications; total error

Corresponding author: Prof. Mario Plebani, Department of Laboratory Medicine, University-Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy Phone: +390498212792, Fax: +39049663240

Received: 2011-3-8

Accepted: 2011-3-8

Published Online: 2011-06-13

Published in Print: 2011-07-01

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Articles in the same Issue

https://doi.org/10.1515/CCLM.2011.617

Keywords for this article

brain-to-brain loop; clinical risk management; extra-analytical indicators; patient safety; quality specifications; total error