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national standards are there any that address what organisms should/or should not be reported on different culture types ? our drs. are concerned that if normal flora organisms are reported on cultures there will be unnecessary treatment given. they feel that micro techs should made judgement decisions on organisms isolated as to what is important and what is not . we feeluncomfortable because we don'y know what the patient's symptoms are ,and feel if the dr ordered the culture he wants to know what's there. what do you think?
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Your question raises an important issue about the role of the laboratory in evidence-based medicine. The old thinking was that the laboratory just performs the test and it is up to the physician to figure out what the results mean. The new thinking is that laboratorians should act as consultants, not just someone who provides a service. The Clinical Laboratory Improvement Act is very clear on this point and it holds the laboratory (not the physician) responsible for every step in the testing process including the pre-analytical, analytical and post-analytical stages. The post analytical process is perhaps where the laboratory can exert the most influence and includes result reporting, result interpretation and post-test specimen management. This means that we tell the physician what the result is, what it means, and what follow-up testing should be performed if indicated. Some examples of this would include: performing FTA-ABS on RPR positive samples, or performing EBV serology if MonoSpot test is negative. In microbiology it means reporting that coagulase-negative staphylococci in a single blood culture set are probable contaminants or that an abdominal wound with > 3 pathogens contains mixed fecal flora. Most physicians are not trained in laboratory medicine and would have no idea what the sensitivity or specificity of any particular test might be. They are not taught the limitations of test procedures and don’t know what the best confirmatory tests might be. It is up to the laboratory to take the lead and optimize our role as laboratory consultants. Having said all this there is unfortunately no “national standards” for test reporting or test interpretation in microbiology. Practice guidelines evolve from the practices carried out at the larger medical center laboratories and eventually evolve into consensus work practices that are then shared through various forums such as seminars, workshops, and professional list servers (eg. Div C List Serve). Some practices appear in print form in textbooks, review articles and newsletters. There are two written documents that I recommend you start with. One is the Clinical Microbiology Procedures Handbook, 2nd ed. available from ASM Press. Another is Koneman’s Color Atlas and Textbook of Diagnostic Microbiology, 6th ed. 2006 pp. 39-44. When working on mixed cultures or cultures containing normal flora, do not list everything that grows and let the physician try to figure out what it all means. If you perform identifications and susceptibility testing then the physician is going to think that you think it is important and that’s why you identified everything. Do not work in a vacuum. Part of your role as laboratory professional is to have more frequent dialogue with the physicians who use your services. If you don’t know the patient’s condition and question whether a specimen needs to be worked up further then give the physician a call and discuss your concerns. It sounds to me from your question that the doctors at your institution want you to take on a more responsible role. Embrace this. It is your opportunity to practice laboratory medicine in the way it is suppose to be practiced.
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