Can You Read Me Now?

Posted December 15, 2008

Making Sure Your Lab Reports Are Easy to Understand

Whether you communicate test results electronically, by fax, or on paper, you (or someone you designate) should periodically review the content and layout of the reports to make sure they are as useful as possible. Are the clinicians and caregivers who receive the reports getting the information they need to treat the patient? Is the information clear, accurate, and laid out in such a way that the readers don’t have to struggle to comprehend the data?

Easy Places to Start

Periodically (at a minimum, annually) review all versions of your reports, with the goal of increasing their quality, accuracy, and interpretability. Also review your reports whenever there has been a readability complaint or after a change in testing methodology.

• Make the font size large enough. The report should be quickly and easily readable, at arm’s length, in imperfect lighting, by someone wearing bifocals. The smaller the font, the greater the likelihood of misreading the value.
• Perform legibility tests:
  • Fax a sample of your reports to yourself. Are the numbers and text small and fuzzy or are they clear and legible? To simulate what your customers may see, repeat the test using the fax you just received.
  • If your reports are being read via a hospital or practice management computer system, verify that your reports display appropriately and legibly on the systems the physicians are using to read the reports.
• Check for complete patient information, including full name, date of birth, and gender.
• Check for specimen source/type, reference ranges or target ranges, and flags ( if indicated).
• Check that Medical Director, facility name, and contact details are on every page of every report.
• Verify any calculated results.
• Check for coding and billing information and any pay-for-performance indicators—e.g., PQRI codes.
• Review the clarity of the interpretation and any comments—e.g., are interpretations clearly associated with the related result?
• Check for reference to prior results, if any. If the result is a critical value, make sure the report includes documentation of appropriate communication—e.g., who notified whom? When? How?

Digging Deeper

There is a lot at stake in one simple lab report. In one study, surgeons misunderstood pathologists’ reports 30% of the time (Powsner). These additional steps can help improve the usability of your reports:

• Standardize the “look and feel” of your results to make them easier to interpret. Putting the same information in the same place, time after time, trains your readers to locate what they are looking for.
• Don’t crowd the data on the page; use sufficient white space to separate columns and lines of numbers.
• All the text should be a good distance from the margins, so no text gets cut off when printing or faxing.
• Enhance your reports with electronic tools such as embedded links to references or other background information—even photos.
• Implement synoptic reports.
• If you use paper charts, consider how you present summary reports and how frequently they are replaced.
• Ask the report recipients for feedback about the information and its presentation. How could you improve the quality and usability of the reports?

Tell the Story

After you have implemented your reporting changes, toot your horn with the administration. Show them the before and after test result reporting formats. Share the metrics of the improvements, including the number of times the improvements will be encountered by clinicians, and the resulting positive impact on patient care.

Helpful Resources

• Mark A. Best, MD, MBA, MPH. The Institute of Medicine’s report on medical error: implications for pathology (letter to the editor). Arch Pathol Lab Med, 125:1274–1274, 2001.
• CAP Cancer Protocols and Checklists.
• Bruce Friedman. The EMR as a data shredder: implications of a single-source-of-truth policy. Lab Soft News blog article, posted September 26, 2008.
• Jeffrey D. Goldsmith, MD, Gene P. Siegal, MD, PhD, Saul Suster, MD, Thomas M. Wheeler, MD, and Richard W. Brown, MD. Reporting guidelines for clinical laboratory reports in surgical pathology. Arch Pathol Lab Med, 132:1608–1616, October 2008.
• Margaret L. Gulley, MD, et al. Clinical laboratory reports in molecular pathology. Arch Pathol Lab Med, 131:852–863, 2007.
• Seth M. Powsner, MD, José Costa, MD, and Robert J. Homer, MD, PhD. Clinicians are from Mars and pathologists are from Venus: clinical interpretation of pathology reports. Arch Pathol Lab Med, 124:1040-1046, July 2000.
• Edward R. Tufte. The Visual Display of Quantitative Information. 2nd ed. Cheshire, CT: Graphics Press, 2001.
• Paul N. Valenstein, MD. Formatting pathology reports: applying four design principles to improve communication and patient safety. Arch Pathol Lab Med, 132:84–94, 2008.

Send your comments to practicemanagement@cap.org.

Laboratory Medical DirecTIPs is an informational series designed for laboratory medical directors (LMDs). The monthly briefs, produced by the CAP’s Practice Management Committee, aim to broadly identify steps LMDs may want to consider in the context of their essential role in quality patient care and promoting the value of that role. Each LMD, of course, must decide, depending on his or her facility’s needs, constraints, local practice standards, and applicable legal requirements, whether the identified steps will be beneficial.

While the DirecTIPs series is intended to present information consistent with laboratory accreditation standards and other regulations, the CAP is not responsible for any errors or inconsistencies with applicable requirements. If an LMD concludes there is a conflict between information presented in the DirecTIPs series and applicable legal requirements, then accreditation standards and regulations obviously supersede the information presented in DirecTIPs.

The series is available to all CAP members. To add, change, or remove your e-mail from the DirecTIPs distribution list, e-mail us.

Related Links

• CLIA Laboratory Requirement
  
  Standard; Laboratory director responsibilities:
  
  e-CFR §493.1445(8) Ensure that reports of test results include pertinent information required for interpretation.

• CAP Standards for Accreditation
  
  Standard I—Director
  
  Interpretation
  
  Qualifications, Responsibilities, and Role of the Director:
  
  1.  Medical Significance, Interpretation, and Correlation of Data—Provide consultations about the medical significance of clinical laboratory data. Interpret, correlate, and communicate laboratory data to clinical requestors.

• CAP Accreditation
  Checklist(s)
  
  GEN  Laboratory General
  TLC  Team Leader
         Assessment of Director
         & Quality
  ANP  Anatomic Pathology
  CHM  Chemistry and
          Toxicology
  CYG  Cytogenetics
  CYP  Cytopathology
  FLO  Flow Cytometry
  FDT  Forensic Drug Testing
  HEM  Hematology &
         Coagulation
  HSC  Histocompatibility
  IMM  Immunology
  LSV  Limited Service
         Laboratory
  MIC  Microbiology
  MOL  Molecular Pathology
  POC  Point-of-Care Testing
  RLM  Reproductive Laboratory
  TRM  Transfusion
  URN  Urinalysis