If the "remarks" on the test report are no longer notes, but "analytical opinions", then what is the value of such a test report?
Value one
Build bridges between clinical departments
Patients, female, 32 years old, atrial fibrillation, alpha gong 5 results showed thyrotoxicosis.
Inspection analysis report: TG-AB, TPO-AB and TRAB are recommended to further confirm the diagnosis.
Follow-up: the emergency department added these three tests to the patient, the result was TRAB positive, TG-AB, TPO-AB was negative, and then endocrine consultation was requested, which was clearly GRAVES disease, and rapid drug treatment.
Value embodiment: The emergency department mainly faces acute and critical patients, for the patient, the clinician realizes that atrial fibrillation may be related to thyroid dysfunction, prescribes a basic thyroid examination item, the test found that the patient is a first-time patient when the report is reviewed, the results show that it is thyrotoxicosis, but there are many causes of thyrotoxicosis, it is very important to clarify the cause, and the treatment plan for different causes is completely different.
As testers, we understand that we can also provide other test indicators to help patients make a definitive diagnosis (the value of test paths). This test analysis report gives clinical advice and shortens the time for patients to visit. Without this report, when the endocrinologist consults and the endocrinologist asks for these three items, the patient's visit to the emergency department will be greatly extended (estimated to be extended by 1 to 2 days or more), and it will also squeeze out the already exhausted emergency resources.
And there is this report, the clinic only needs to apply again, the patient does not need to draw blood again, with the original specimen immediately added, the results come out, the endocrinologist will consult, immediately clear diagnosis, rapid treatment. It is the patient who ultimately benefits.
Value two
Early prevention of the occurrence of disease
Patient, female, 34 years old, admission: Patient entered the nephrology department for "regular dialysis for 5 years, bone 3 months".
Test analysis report: It is recommended to add bone metabolism markers, improve parathyroid ultrasound and parathyroid MIBI fusion imaging, and determine whether THPT occurs? If there is early treatment.
Follow-up: The patient was clinically applied for bone metabolism markers, parathyroid ultrasound and parathyroid MIBI fusion imaging, confirming that the patient did have THPT, through thyroid surgery consultation, transthyroid surgery, and surgical resection of hyperplastic parathyroid glands.
Value embodiment: When reviewing biochemical reports, in addition to paying attention to critical values, other projects also need to pay close attention.
Patient CDK5 stage, ALP is elevated at the same time high blood calcium and high blood phosphorus, through LIS found that the same period of PTH is significantly increased, and then look at HIS, the patient has bone pain in March performance, coupled with our previous related research results, combined together: this information is highly directed to the patient may have THPT, at this time the test person needs to be reminded in time. Without this analysis report, changes in these indicators may be noted, and may also be clinically focused on the most urgent dialysis treatment or other complications that need to be dealt with immediately, without paying attention to the changes in indicators, if not transferred to surgery in time, the consequences will be terrible severe bone destruction and fractures.
A report, timely transfer treatment, to avoid the occurrence of fractures, to achieve the value of preventing the occurrence of diseases. In the end, it is the patient who benefits.
Why are we sending out this inspection analysis report? I don't want history to repeat that scene.
Three years ago, on April 27th, a patient with a fractured femur neck was admitted to thyroid surgery.
Looking back at the history of the male patient, there was a year of changes in indicators to the occurrence of fractures, and it has been waiting for a pair of wise eyes to discover the truth, perhaps due to the limitations of our cognition or the usual lack of attention, it is a pity that we did not wait for us to find out.
Now, this result is before our eyes. Are we lightly judging out and waiting for the clinic to discover the changes in the disease? Or is it timely reminders to attract attention? If there is no attention, the patient ends up with a fracture. Are we responsible?
If the patient really has a fracture, in fact, it could have been avoided, who do we blame? Obviously we have seen it, choose not to speak up, waiting for others to find out? If a subsequent patient does have a fracture, will we regret it? Will our hearts hurt?
A teacher sent me a message yesterday, if it were you, how would you choose?
Value three
Discover the truth about the disease
Laboratory analysis report: In the biochemical report review, it was found that the patient had abnormally elevated ALP, and at the same time hypercalcemia and hypophosphorus appeared, and it was recommended to add bone metabolism markers and PTH by telephone, and after these test results came out, a test analysis report was issued for the clinic, thinking that there was a PHPT possibility, and it was recommended to consult the endocrinologist and transfer treatment in time.
Follow-up: After consultation with the endocrinology department, he was transferred to the department of endocrinology, and further improved the parathyroid ultrasound and MIBI fusion imaging to determine phPT, and then transferred to thyroid surgery.
Value embodiment: This is a heart-wrenching story, a young girl has bone and joint pain and other symptoms for a year, and at the same time, she has shrunk her height by 6cm in 9 months of physical examination at school, and has been treated in other places for a year, and has always believed that nerve damage treatment is ineffective and came to West China.
A routine biochemical examination on the first day of admission basically clarified the truth of the patient's illness for a year. There are also critical values for such abnormal results, should we notify the critical values and record them and end them, or should we explore the truth behind these abnormal numbers? If the truth of the disease is discovered, we are buried in the heart and do not say anything, and when the patient discovers the truth of the disease after a tortuous process, we collect this case and talk about how important the test is, the clinical eye, and the disease scout.
I believe that this patient in the field of three A hospitals in the past year, must have done many examinations, there will be many times this abnormal biochemical results, if the first time to see the doctor, you will find the problem, timely treatment. Maybe it won't affect her year's study, let alone shrink her height by 6cm. Someone asked me, can I still grow back in height? Unfortunately, I can't go back.
The original biochemical inspection was done by ourselves, and the results were also produced by us, what is the significance of our audit report? Just to see if there is a negative value ? Is the result a missing item? Is there a critical value ? If not, give a raw naked result? Are we really just working as technologists to make results without having to analyze them? If we want to see the results, what should we look at? If you look at the problems behind the numbers and find them, are you also buried in your heart, waiting for the clinic to discover them? Our remarks can only be liposylmolysis? Why can't we learn from imaging, pathology, etc.?
If God gives you a chance to do it all over again, and when this result is before us, what is your choice? What is the role of your Scout?
The patient's experience made me understand the importance of testing, and since then I have understood that the test should not only be done well, but also need to look at the results, and more importantly: how to convey the information behind the numbers to patients and clinics in a timely manner. There are many ways to communicate, such as telephone, oral, WeChat, written, the most direct and effective way should be to give the inspection and analysis report.
Value four
Save lives at critical moments
A patient in the outpatient thoracic surgery, the test results appear troponin elevated, for outpatients, originally only need to send out the results, by the HIS system to issue a critical value prompt, considering that the patient is out of town, while his body shows chest pain, or want to call the patient to understand the situation, the result of the patient phone shutdown, and then think about if the patient shuts down, the hospital HIS system can not notify the results, the only way to think of at this time is to write him a test analysis report, I hope that after he takes the report, he can see the following text and go to the emergency chest pain center immediately.
After the patient took the report, he should have seen the text below the report, immediately went to the chest pain center of our hospital, and finally it was clear that a myocardial infarction had occurred, and he was discharged from the hospital after being admitted to the CCU and performing PCI.
If there is no recommendation of this test analysis report, will the patient leave the hospital, wait for a week later to come to Huaxi to see the chest clinic, will his life disappear on the way home?
Inspection of problems in the analysis report
For the emergence of a new thing, since there is no model to borrow, there will always be many problems. Mainly reflected in:
Information mastery: the laboratory has not seen patients, the understanding of clinical information is relatively small, even if there is a HIS system, the understanding through words is still not comprehensive enough.
Testing people's knowledge: Due to the different educational curriculum, there are obvious differences in the study of laboratory and clinical professional courses, and the mastery of the disease is obviously insufficient.
Understanding of other tests: When analyzing a patient, in addition to test knowledge, it is also necessary to understand the results of other tests such as imaging, ultrasound, pathology, etc., which is easier to do, because these test results have conclusions and text descriptions. The ability of the tester to learn to look at other results is obviously insufficient.
There is a risk of medical disputes: such as different from clinical views, incorrect analysis of results, incomplete analysis of results, etc.
Examine the advantages of people looking at the results
The advantages of the tester looking at the results: the production of an examination result is a complex process, involving whether the patient's preparation is appropriate, whether the sample collection is reasonable, the impact of interference in the analysis on the results, and the discovery of incorrect results are obviously superior to the clinic.
At the same time, the examiner will analyze the results impartially from the test figures, and there is no clinical due to long-term contact with a certain type of patient, often with preconceived notions, considering the diseases that they are familiar with and thinking about it is not comprehensive enough, especially specialists.
It has a huge role in promoting the development of the inspection discipline
It has a huge role in promoting the development of the laboratory discipline: whether it is teaching or clinical frontline, the inspector looks at the results and analyzes the inspection report, clarifies the direction and positioning of the laboratory profession, and has a clear goal from the aspects of curriculum setting, training objectives, and teaching content, and substantively promotes the development of the clinical laboratory diagnostics profession.
On the other hand, from the substance to promote the improvement of inspection quality, the inspector to analyze the results, the premise is to do a good job of testing, in the correct results to analyze, so that everyone understands the importance of the test results, so as to reverse the improvement of the quality of the test, rather than empty to ask for quality, so that the inspector understands what is the meaning of doing this? Rather than simply asking to do it.
If you are a patient, do you want the test report to have a text description of the image, ultrasound, or pathology instead of a string of numbers?
If you're a clinician, would you rather have a test report with an analysis of the results, or do you look at it yourself?
Testing people's clinical knowledge and pharmacological knowledge, must be combined with the patient's specific medical history analysis, it is very important to understand the medical history and treatment process, leaving the specific patient to analyze the results is meaningless.
Producing analytical reports requires long-term accumulation of knowledge and a process of continuous clinical learning. At least 4 processes are required: basic theoretical knowledge learning, clinical learning stage (learning clinical thinking), growth stage (self-analysis and clinical comparison), and daily work stage (application in ordinary work). The process can range from years to decades.
This road is the only way to test, and the current national implementation of the combination of clinical, case analysis, testing and clinical integration is already on the road. Since it is the beginning, everything needs to be improved, which is related to the development and future of the laboratory discipline, so it is more necessary to top-level design, the need for provincial or national medical associations or physician associations or higher level of examiners to lead, including the problem of laws and regulations, the problem of how to cooperate with the inspection education (including the teaching materials may need to be rewritten), the problem of how the inspection education changes, how to train interns, how to set the post, how to change the remarks, what name to change, how to write the analysis report, how to standardize, How to avoid medical disputes and a series of other issues.
Doing this may be the top priority of the current test, how to promote it? How to regulate? We need more testers with the right to speak to guide, we test there is a lot of expert consensus, perhaps we need a test analysis report expert consensus.
Source: Your teacher
Editor: Ren Mileage Reviewer: Xiao Ran