ABSTRACT
As the clinical laboratory test menu has significantly expanded in volume and complexity, there is a rapidly growing need by clinicians for narrative interpretations of complex studies that resemble those provided in anatomic pathology and radiology. In this report, the impact of advice on laboratory test selection and interpretation is presented with regard to providing adequate quality of care, reducing medical error, and reducing the cost for health care. In addition, past and current attempts to address the physician's need for advice on laboratory test selection and interpretation are also described. These include curbside consultations, intelligent laboratory information systems, and medical information from the Internet. Each is presented with examples from the literature and with its advantages and disadvantages for practicing clinicians confronting large, expensive test menus and the results of esoteric assays.
Subject(s)
Clinical Laboratory Techniques , Interprofessional Relations , Clinical Laboratory Information Systems , Humans , Internet , Medical Errors/prevention & control , Quality of Health Care , Referral and ConsultationABSTRACT
The use of reflexive test selection and patient-specific narrative interpretations in laboratory medicine is associated with a host of compliance issues and government regulations. Reflexive testing is associated with many advantages for patients and their physicians, but if not adequately organized it has the potential for inefficient test ordering and abuse by physicians and laboratories. Patient-specific narrative interpretations in laboratory medicine, much more than fixed comments generated by a computer with a specific test result, also provide clinical and financial benefit when done effectively. Regulations exist to ensure that the physician-provided information has clinical value. This report describes the compliance and billing regulations regarding reflex testing and narrative interpretations. The codes used for narrative interpretations in laboratory medicine are also presented, as well as the use of those codes to obtain payment for the interpretation provided.
Subject(s)
Clinical Laboratory Techniques , Algorithms , Clinical Laboratory Techniques/economics , Health Care Costs , Humans , Laboratories , Medical Records , Physicians , Reimbursement MechanismsABSTRACT
The logistical details for organizing effective interpretive rounds in a laboratory medicine subspecialty must be carefully established so that expert opinions are provided in a timely fashion in a patient-specific report, rather than as a collection of fixed comments associated with a particular laboratory result generated by a computer This report describes the test batteries for interpretations, the billing for interpretations, clinical examples of interpretations, and interpretations for which billing is not typically performed in several clinical or laboratory areas in our institution. These include coagulation disorders, hemoglobin and anemia evaluations, autoimmune disorders, serum protein analysis, toxicology, molecular diagnostics, and transfusion medicine. The information in this report should provide sufficient detail to allow development of interpretive services with successful billing for the areas in laboratory medicine described.
Subject(s)
Clinical Laboratory Techniques , Anemia/diagnosis , Autoimmune Diseases/diagnosis , Blood Coagulation Disorders/diagnosis , Blood Protein Electrophoresis/economics , Blood Transfusion/economics , Clinical Laboratory Techniques/economics , Expert Testimony , Humans , Medical Records , Molecular Biology , Reimbursement Mechanisms , Toxicology/economicsABSTRACT
BACKGROUND: Fatty acid ethyl esters (FAEEs) are cytotoxic nonoxidative ethanol metabolites produced by esterification of fatty acids and ethanol. FAEEs are detectable in blood up to 24 h after ethanol consumption. The objective of this study was to assess the impact of gender, serum or plasma triglyceride concentration, time and temperature of specimen storage, type of alcoholic beverage ingested, and the rate of ethanol consumption on FAEE concentrations in plasma or serum. METHODS: For some studies, subject were recruited volunteers; in others, residual blood samples after ethanol quantification were used. FAEEs were isolated by solid-phase extraction and quantified by gas chromatography-mass spectrometry. RESULTS: For weight-adjusted amounts of ethanol intake, FAEE concentrations were twofold greater for men than women (P /=24 h. The type of alcoholic beverage and rate of consumption did not affect FAEE concentrations. CONCLUSION: These studies advance plasma and serum FAEE measurements closer to implementation as a clinical test for ethanol intake.
