017 - Patient Safety and Laboratory Medicine
Autor(s): P. Cappelletti
Issue: RIMeL - IJLaM, Vol. 2, N. 3-S1, 2006 (MAF Servizi srl ed.)
Page(s): 17-35
In the first section we look back at the re-discovery of errors in Medicine starting from the seminal report by the Institute of Medicine (‘To err is human’). Changing the mindset from the inquisitive attitude to ‘find out the guilty’ to a proactive policy for patient safety aiming to identify and prevent the latent mistakes and to disclose and discuss in detail all the adverse outcomes must be seen as the big challenge facing both the cultural and technological potential of any healthcare organization. Taking into consideration just the two more ‘reactive’ systems, namely in the U.K. and U.S., increasing amount of evidence stands for a growing effort in achieving high standard of performance both in public and private sectors, with much more attention paid to safety issues. The new gospel is waiting for a capillary diffusion, probably because effective tools are not at hand, but ambitious targets have already been proposed, such as a 90% reduction of nosocomial infections and a 50% decrease in therapeutic mistakes. The second part is devoted to the topic “Errors in Laboratory Medicine”, starting from the very definition of what is an error in Laboratory Medicine, how it could be detected and classified according to the principles of Risk Management and the acknowledgment of the priority of patient safety in all the steps of the Lundberg’s loop, up to the related standards and quality indicators. The classical and familiar quality control schemes, the renewed quality improvement essentials, the prescriptions and suggestions made by institutions and regulatory bodies, the application of specific tools based on a detailed analysis and detection of error frequency, are all necessary transitions to the goal of a sincere change in mindset toward an open disclosure of pitfalls and failures and a pro-active analysis of the total testing process. Borrowing from Steven Woolf his “big picture” concept, patient safety in Laboratory Medicine can be represented as a series of concentric circles: assured results (analytic quality), assured processes (total testing process quality), assured outcomes (appropriateness and effectiveness) and, finally, patient - as tax payer citizen - safety (social role of Laboratory Medicine). The whole picture must be solidly rooted on the Knowledge base provided by the evidencebased laboratory medicine (EBLM), in spite of a number of hindrances such as a partial coverage of many pathophysiological and clinical areas by EBLM studies, the unhomogeneous approaches to the evidence informed practice and, last but not least, some ‘ideological’ criticisms to EBM. Laboratory Medicine has many things to say in this field. Finally, a genuine commitment to patient safety is a most favourable standpoint to address the very core of the Discipline, in an ideal, not fortuitous connection with the topics of our two last national Meetings devoted to the clinical effectiveness of Laboratory response and to the technological and organizational solutions proposed by Laboratory professionals to fulfil their mission. These three perspectives, kept together, offer the best possible framework to describe the essence of Laboratory Medicine.