Clinical pathologists can play a key role in preventing a major source of error outside the laboratory—namely, improper selection of tests and incorrect interpretation of test results, Michael Laposata, MD, told CLIAC members. Medical error is becoming a more serious problem, he said, as the test menu gets larger and more complex, particularly in molecular diagnostics.

Board-certified in clinical pathology, Laposata is director and chief of the division of clinical labs at Massachusetts General Hospital (MGH) in Boston. He also is a professor of pathology at Harvard Medical School.

He said clinical pathologists should be proactive in establishing lab medicine consultations, both on and off the hospital floor. This would help shorten the time to diagnosis and improve the accuracy of diagnosis, thereby saving money and improving outcomes for the patient, whose care is subject to the variable knowledge of non-experts in lab medicine.

Minimal turf issues have occurred in lab medicine interpretative rounds at MGH, Laposata said. Currently active: coagulation, autoimmune disease, anemia, transfusion reactions, serum protein analysis, HIV, and hepatitis.

He recommended two strategies to improve test ordering and results interpretation:

• Use reflex testing as much as possible to increase the appropriateness of test selection. The MGH clinical lab uses about 100 reflex test algorithms in all areas of lab medicine.
• Provide patient-specific narrative interpretations of test results, as is done in anatomic pathology and radiology, for complex evaluations in lab medicine.