Support Tests.

Knapp, Lucy LKnapp at PEACEHEALTHLABS.ORG
Mon Jan 25 20:03:28 UTC 2016


It is the same test – but the interpretation is very different.  This is an example of where we should do better. We need to communicate clearly with each other, doctors need to know the difference with the two tests. Although the test method is the same; the physicians are looking for something very different. A result of 1.2 ng/mL on a screening test is completely normal – the same result on the diagnostic test is very abnormal.

I’ve run into the same sort of thing with thyroid testing – I have no thyroid due to thyroid cancer. My “normal” isn’t at all what a “normal” would be with the average patient.

Lucy

Lucy Knapp, MT(ASCP)   |  Technical Specialist, Chemistry  |  Laboratory
PeaceHealth<http://www.peacehealth.org>  |  400 NE Mother Joseph Place  |  Vancouver, WA 98664
office 360-514-2732  |  fax 360-514-1646

From: Sherri Loeb [mailto:sherriloeb at gmail.com]
Sent: Monday, January 25, 2016 11:41 AM
To: Society to Improve Diagnosis in Medicine; Knapp, Lucy
Subject: Re: [IMPROVEDX] Support Tests.

I find this comment particularly interesting considering my husband passed away from metastatic prostate cancer. One he was diagnosed. We noticed that occasionally his psa was ordered as psa screening to check response to chemo and hormone therapy and other times as psa diagnostic. We were told it is exactly the same. From reading this email, it is obviously not the same.

Thanks for the clear explanation.

Sherri Loeb RN, BSN

On Mon, Jan 25, 2016 at 1:01 PM, Knapp, Lucy <LKnapp at peacehealthlabs.org<mailto:LKnapp at peacehealthlabs.org>> wrote:
In a word – speaking for the laboratory world – Communicate those needs to your laboratories. As an example, here we have two tests, “PSA, Screening” which has a reference range up to 4 and “PSA, Diagnostic” which also has a reference range of up to 4 but also includes an interpretative comment: “According to the American Urological Association (AUA), serum PSA should decrease and remain at undetectable levels after radical prostatectomy. The AUA defines biochemical recurrence as an initial PSA value of greater than or equal to 0.20 ng/mL followed by a subsequent confirmatory PSA value of greater than or equal to 0.20 ng/mL.”

In a prior life – we had 2 tests with different reference ranges, plus a comment on the PSA, Diagnostic. Both options are easily done in an LIS (lab information system).

We in the laboratory would love to have better communication from physicians – we want to make your lives easier. So my advice to all the physicians out there is to build relationships with the pathologists and laboratory personnel where you practice. Let us know where improvement is needed to the LIS, you need a new test, you need better sensitivity on a current test – whatever.

I’m copying the to our medical director, we are trying to establish better communication with our physicians throughout our system.

Lucy

Lucy Knapp, MT(ASCP)   |  Technical Specialist, Chemistry  |  Laboratory
PeaceHealth<http://www.peacehealth.org>  |  400 NE Mother Joseph Place  |  Vancouver, WA 98664
office 360-514-2732<tel:360-514-2732>  |  fax 360-514-1646<tel:360-514-1646>

From: robert bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>]
Sent: Sunday, January 24, 2016 1:56 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Support Tests.

I have suggested that at the same time, or even before we tackle Errors in Diagnosis, we see that all our support diagnostic tests (Lab, X-ray, etc.) are in good order so as to help make the correct diagnoses more often.

I have been made aware that it is easy to miss a low but rising PSA in someone who has had a past radical prostatectomy.

The Lab reports results as ng/mL with a reference range of (0.000 - 4.000). The range for someone with a prostate present.

I asked myself with all the technology is there anything that could be done to prevent such happenings?

And then I thought there must be 100s of similar situations when time, disease, surgery, treatments, etc effect lab interpretations - the PSA lab reports on the ones I have seen do not mention that the ranges are for someone with a prostate. Should they?

Yes, good clinical skills would help but could the lab with or without technology do anything to help avoid such problems?  Could training or anything else help prevent?

I wondered how often this happens - and if you decided to do something about it, could you triage it - presumably not without good error data!?

Robert Bell




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