Clinicians’ Compliance with Requirements on Surgical Pathology Laboratory Request Forms

Samuel Robsam Ohayi 1, Mark Sunday Ezeme2 and Nkiruka Nonyelum Okoloagu3

1Department of Histopathology, Enugu State University Teaching Hospital and College of Medicine, Enugu, Nigeria

2Department of Psychiatry, Enugu State University Teaching Hospital and College of Medicine, Enugu, Nigeria

3Department of Ophthalmology, Enugu State University Teaching Hospital and College of Medicine, Enugu, Nigeria

Correspondences to: Dr. Samuel Robsam Ohayi Email: samuel.ohayi@esut.edu.ng

Received: 05 Mar 2021; Revised: 07 Sep 2021; Accepted: 15 Sep 2021; Available online: 20 Nov 2021

Abstract

Background: Early and accurate diagnosis has a major impact on outcome of diseases. Prompt delivery by the laboratory on requests sent by clinicians is fundamental to this. For useful laboratory outcomes, clinicians should provide comprehensive information, as required in laboratory request forms. The aim of this study was to analyze how well clinicians complete laboratory request forms. Methods: This is a retrospective descriptive study from January 1 to December 31, 2017. Laboratory request forms submitted with laboratory requests were retrieved and reviewed for completeness of required information. Results: An error prevalence of 12.2% was observed from the analyzed requests, and the average number of errors per request was 1.7. Surgical specialties contributed by far the most errors (t=-7.571; p=0.0000), and biodata information was the group that was mostly omitted from laboratory forms. Conclusion: This study revealed that clinicians submit requests with various irregularities, including suboptimal information, to the histopathology laboratory of our hospital. Regular interaction between clinicians and pathologists is needed in order to enlighten clinicians on the importance of providing necessary information regarding their requests to the laboratory.

 

Keywords: Laboratory request forms, Accurate diagnosis, Clinicians, Pathologist, Histopathology, Laboratory form errors, Nigeria

 

 Ann Afr Surg. 2022; 19(1): 8-15 

DOI: http://dx.doi.org/10.4314/aas.v19i1.3 

Conflict of interest: None

Funding: This study was funded by Mekelle University.

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License

Introduction 

Early and accurate diagnosis has a major impact on disease outcomes. Prompt delivery by the laboratory on requests sent by clinicians is fundamental to this. Over time, the laboratory has become a major contributor to disease diagnosis and patient management. Some researchers have reported that pathologists’ outputs were relied upon for clinical decisions in 29–98% of patients attending their hospital and that the variation is according to the care area where medical services were rendered to patients namely outpatient care, emergency

 

department and inpatient care (1). For useful laboratory outcomes, coherent, adequate, and timely communication must flow between the clinician and the pathologist. The laboratory request form is the main methods by which clinicians communicate patient’s clinical information to the pathologist. The pre-analytic phase of specimen handling, which includes filling of laboratory request forms, is believed to be the most critical phase and also the phase most prone to error (2, 3).

Laboratory requests received in histopathology are mostly from surgical specialties, but other clinicians, namely dermatologists, nephrologists, gastroenterologists, and family physicians, also send requests. Added to other factors, progressively sophisticated surgical techniques are leading to an increase in the number of specimens sent for histopathological analysis and therefore increased workload for pathologists(4, 5). An increase in workload complicated by irregularities in laboratory request forms can lead to frustration for pathologists and leads to the possibility of diagnostic errors. Clinicians contribute to laboratory errors mostly through inappropriate laboratory requests and absent, incomplete, or erroneous clinical information in laboratory request forms, among others (6). These failures lead to prolonged turnaround time (TAT) with possible inability of the pathologist to make a diagnosis or the pathologist arriving at an incorrect diagnosis. This is possible because the delays may result in degradation of the specimen provided for laboratory analysis. This could result in an unnecessary treatment (eg, biopsies for a patient or further but unnecessary testing outcomes), which may cast doubt on the healthcare delivery system as a whole(7).

To mitigate these avoidable errors and their attendant consequences, continued frank communication between the pathologist and the clinician is needed. Such communication can be improved if the areas of clinician errors are known by the pathologist. The aim of this study was to analyze how well clinicians complete laboratory request forms that they send with specimens for histopathological analysis in order to achieve better laboratory outcomes and therefore enhance clinical care of patients.

Materials and Methods

This is a retrospective descriptive study from January 1 to December 31, 2017. It was carried out in the histopathology laboratory of a university teaching hospital. The laboratory receives specimens from the hospital and other hospitals in the city of Enugu and surrounding areas. Specimens are received from surgical specialties and non-surgical specialties, namely dermatology, gastroenterology, nephrology, and family medicine, and from general practitioners as well. Requests from hospitals other than ours were excluded from the study because those hospitals may be using a different request form and thus may not have known the nature and/or extent of information required by the laboratory. Ethical approval for this work was obtained from the ethics committee of the hospital.

Histopathology (surgical pathology) request forms were retrieved from the laboratory archives, and appropriate data was extracted from them into a proforma created for the purpose