Ensuring Quality Results for Your Patient

2009, Volume 20, Number 1


David F. Keren M.D.

If you order prenatal screening, autoimmune testing, testing for plasma cell myeloma or one of many other tests performed at Warde Medical Laboratory, you may receive a call from one of our Client Services representatives, or even me about one of your patients. Sometimes, it is the best way to ensure quality and direct communication on some issues that can affect your patient’s care.

For instance, in autoimmune testing, some assays such as anti-neutrophil cytoplasmic antibody (ANCA) along with antiglomerular basement membrane antibodies (anti-GBM) can provide information that may require timely intervention in individuals who have rapidly progressive glomerulonephritis or hemoptysis as part of microscopic vasculitis or Goodpasture’s syndrome. Such individuals may be in danger of losing their kidney function where immediate therapy with powerful anti-inflammatory agents, such as Cytoxan could prevent them from needing dialysis or a kidney transplant. Because of this, when we find a positive ANCA in the serum from a patient not formerly known to us to have these autoantibodies, we call the originating office or laboratory to let them know about this development.

With prenatal screening, we make proactive calls in screen positive cases because some patients could have a false screen positive report due to an error in communication of clinical information. Correct clerical information is needed to make the appropriate risk calculation for the estimate of Down syndrome, Trisomy 18 or open neural tube defect. Because of this, our client services representatives make a call to the office of all potentially screen positive cases and double check the clinical information received before we finalize our reports. On some occasions, when checking the final positive report, our pathologist will request a fax of the ultrasound information because our experience suggests there is a possible discrepancy between the biochemical assay findings and the gestational age provided. Happily, these proactive additional calls prevent many potentially false positive screens each year.

When examining a patient for a monoclonal gammopathy, we review the results of previous samples we have seen from that patient. If there has been a change in the pattern seen on electrophoresis, such as the unexpected loss of the monoclonal protein, or the presence of a new monoclonal protein of a different type, we may contact the drawing site to learn if a patient identification error may have occurred, or we may call the clinician to correlate our findings with recent chemotherapy.

As part of our efforts to provide the highest quality results for your patient, we encourage you and your staff to call us directly if you have a concern about any test that has been performed at Warde Medical Laboratory. You will find our telephones are answered by knowledgeable, courteous individuals who will quickly get you the information you need.