Evidence-Based Practice in Laboratory Medicine

Introduction

The use of evidence-based practice (EBP) has gained great popularity in healthcare facilities in general and in laboratory settings in particular. Having a variety of examples supported by evidence allows medical workers to make better decisions concerning the patients’ health and solve medical cases more efficiently (1). In laboratories, such practice is especially valued since it allows the lab workers to make more precise conclusions. Being one of the most popular diagnostic interventions, laboratory tests, however, do not have sufficient value for the patients unless they provide advantages at an affordable price (2). So far, there is a variety of under-, over-, and misdiagnostic activities in the test utilization procedures. The introduction of EBP in laboratory medicine will secure better health care and higher patient satisfaction levels due to the improved outcomes.

Evidence-Based Practice in Al-Rahba Hospital Laboratories

All the facilities of Al-Rahba hospital are aimed at providing their clients with the best healthcare services. The laboratories of the hospital practice conform to several existing policies whose task is to organize the best care and quality of testing. These policies are guided by EBP that has become an inseparable element of medical education and practice (3). One of the innovations in laboratory testing methods is point-of-care testing. The major function of laboratory workers is providing test results that are appropriate for the designated purpose (3). Therefore, all laboratories in the hospital work to obtain the most relevant measures and eliminate the uncertainty of results.

Al-Rahba hospital’s management takes great care of improving patient outcomes. With this aim, laboratories work in accordance with the following EBP phases: asking the question, looking for evidence, evaluating the evidence and applying it, and appraising the experience (4). The management demands associated with these steps are:

• eliminating underutilization of laboratory testing via a more profound endorsement of evidence-based medicine and guidelines;
• coping with overutilization by means of decreasing the unnecessary or irrelevant laboratory testing;
• engaging in the enhancement of chronic management with the help of proper application of clinical lab testing;
• eradicating the laboratory tests that provide insufficient clinical value as well as those that are outdated and ineffective (1).

The mentioned measures are aimed at enhanced patient compliance, reduced number of episodic events, and better access to timely and relevant care. In order to fulfill these requirements, laboratories in Al-Rahba hospital hire only highly qualified specialists who are able to critically assess the ongoing and probable tests, accommodate customers’ requirements, and manage all laboratory operations in the most productive way.

A Detailed Example #1

One of the conditions on which laboratory tests produce value is when they provide highly precise diagnostic data for clinical decision-making. At the biochemistry laboratory of Al-Rahba hospital, EBP is employed to obtain such data. The relationship between analyses and clinical outcomes is meticulously examined with the help of such a tool as the likelihood ratio (5). This method helps to establish which of the tests are most efficient and how they can be employed in the most productive way.

Apart from that, our biochemistry lab employs such a crucial rule of EBP as a review of evidence obtained during clinical trials (5). The aim of conducting such reviews is to eliminate bias and mistakes. To produce the best outcomes, reviews are double-blinded and randomized. Also, they may involve meta-analysis the results of which indicate the value of specific tests. Therefore, the use of EBP in the biochemistry laboratory gives a possibility to reduce errors and increase the quality of tests.

A Detailed Example #2

Another example of using EBP in Al-Rahba laboratories is how it is employed in the hematology section. In the hematology lab, there is a series of tests aimed at analyzing the cardiac biomarkers (6). The sufficient specimen for such tests are plasma, serum, and anticoagulated whole blood (6). For this department of laboratory work, EBP is particularly significant. The choice of the mentioned specimen is highly dependent on the adequate evidence as well as the established features of individual biomarker analyses.

Our hematology section uses EBP to analyze what types of essays are most sufficient and reliable. By doing so, we can guarantee the elimination of unnecessary tests, which leads to saving time, costs, and equipment. Prior to using the biomarker assays in clinical practice, we check them in order to exclude the possible interferences such as human antimouse antibodies, rheumatoid factors, and heterophile antibodies. Having such data at our disposal allows the lab workers to eliminate errors and save valuable resources. Therefore, EBP highly enhances the work productivity of the hematology section.

Conclusion

It is no wonder that evidence-based practice is becoming a more and more popular method applied in clinical practice. At Al-Rahba hospital, EBP is employed in all departments, including laboratories (hematology section, blood bank, and biochemistry lab). The use of EBP produces a number of positive outcomes. Laboratory workers can reduce the waste of time and resources, eliminate errors, and reach the most positive patient outcomes. The variety of examples presented by EBP allows laboratories to work in the most precise way and produce sufficient test results.

References

1. Badrick T. Evidence-based laboratory medicine. Clin Biochem Rev. 2013; 34(2): 43-46.
2. Horvath AR. From evidence to best practice in laboratory medicine. Clin Biochem Rev. 2013; 34(2): 47-60.
3. Farrance I. Review: policies, procedures and guidelines for point-of-care testing. RCPA Quality Assurance Programs Pty Ltd. Web.
4. Price CP. Evidence-based laboratory medicine: is it working practice? Clin Biochem Rev. 2012; 33(1): 13-19.
5. Bruce H, Lapsley M. Quality aspects of laboratory medicine. In: Marshall WJ, Lapsley M, Day AP, Ayling RM, editors. Clinical biochemistry: metabolic and bioclinical aspects. 3rd ed. New York (NY): Elsevier; 2014. p. 6-20.
6. National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice. Guidelines: analytical issues for biochemical markers of acute coronary syndromes. Clin Chem. 2007; 53(4): 547-551.