Laboratory Facts for Patients
Why Laboratory Tests are Ordered
Doctors and health care practitioners use lab tests to assist in the determination of your overall health, to diagnosis a disease, to establish appropriate treatment or to monitor treatment. Laboratory tests provide valuable information along with your medical history, a physical exam, and other tests to make health care decisions that are vital to promoting better health and longer life for you.
Who Orders and Interprets Lab Test Results?
In the state of Oregon only certain licensed health care professionals, such as your physician, can order laboratory tests. Lab test results are used along with a physical exam and other diagnostic tests to make judgments about your health. For that reason, the doctor(s) or other medical professionals that provide your health care are in the best position to interpret your test results. Consultations with a laboratory pathologist, an MD that specializes in laboratory medicine, are available for all practitioners free of charge.
What can be Tested?
Your body is made up of many different types of cells and fluids. Almost all of these cells and fluids may be tested, though the most common specimens are blood and urine. Materials such as sweat, spinal fluid, joint fluid, sputum, hair, feces, bone marrow, tissues and body scrapings are also analyzed.
How are Specimens Collected?
For blood tests, most commonly, a vein on the inner side of your arm will be selected for a venipuncture. Your physician or laboratory professional will instruct you on the proper collection of urine samples, feces, sputum, semen or other materials which you can collect even at home. Other types of samples, such as spinal or joint fluid, bone marrow and tissues are collected by your physician.
When are Lab Tests Done?
Lab results need to be timely. Most tests are performed and the results are delivered to the doctor who ordered the test within 24 hours. Some tests take longer to complete, which is acceptable if your condition allows. Nearly all test results are reported to the physician within a week.
Sometimes, your state of health may require urgent care and lab results are needed rapidly. These tests are ordered "STAT", a word that comes from the Latin statim, meaning "immediately." Tests ordered STAT are reported to the doctor within minutes or hours if possible. These tests are performed in each hospital.
Can a patient have copies of their results?
The state of Oregon directs laboratories to report results to the ordering practitioner. Under Oregon law, patients may have copies of their reports 7 days after they have been reported to their practitioner, unless the tests were ordered with instructions that specify that the "patient may have results."
A release form is required to be filled out and signed by the patient and results will be sent as designated on this form. To pick up a copy of results, a patient must show identification.
How Accurate are Lab Tests?
Laboratory tests drive a large part of the clinical decisions our doctors make about our health, from diagnosis through therapy and prognosis. Lab test results are useful to the health care practitioner only if the results are accurate, precise, and timely. An accurate test result is one that closely corresponds to its true value. Testing should also be precise. In other words, the results of a particular test should be consistently reliable from patient to patient and from one time to the next. It may be necessary to make sure that the same lab is used for testing from one time to the next.
The accuracy and precision of a particular test depend on many factors. Some tests are inherently more accurate than others. The laboratory takes specific measures to make sure that test results reported to your doctor are as accurate and precise as possible.
Blood test accuracy and precision are constantly monitored by the use of quality controls—specimens that have previously determined results. Controls are specimens that are tested with every "batch" or group of specimens. Their results are known by lab personnel and must closely correspond to their predetermined value. If not, the batch must be repeated. Proficiency testing specimens are controls sent to the laboratory from an outside source—either from a governmental or private organization. The results are unknown to the lab personnel and must be accurately reported for the laboratory to maintain its license or certification.
There are several government and independent organizations which monitor lab testing quality. Among them are HCFA, the Oregon State Department of Health, and the Joint Commission for the Accreditation of Hospitals (JCAHO). These organizations also inspect the laboratory and laboratory records from time to time.
How are Lab Tests Used?
Lab tests are used in three ways:
- Diagnosis -- to help to identify or exclude the presence of a condition or an illness in patients who have symptoms, such as a pregnancy test or a blood count for anemia. Sometimes the test tells the practitioner what stage a disease is in.
- Management -- to determine the prognosis or course the disease is likely to take, monitor how the disease progresses, determine if a disease is recurring, or to help select drugs or other treatment likely to help the patient. Antibiotic susceptibilities that predict how an infection will respond to specific drugs are an example of this type of test.
- Screening -- identifies the risk of disease or medical condition in patients who have no symptoms. This allows for early diagnosis to better treat or to prevent disease from occurring. Good examples are the PSA for prostate cancer, Glucose levels for diabetes, Occult Blood for colorectal cancer or Cholesterol (Lipid panel) for cardiovascular risk.
Medicare will pay for these screening tests under the following conditions:
- Cholesterol, Triglycerides and HDL (Lipid panel): 1 time every 5 years. You must fast for 12 hours. Your provider must order the test as a Medicare lipid screen with one of these specific diagnosis codes: screening for ischemic heart disease (code V81.0), screening for hypertension (code V81.1) or screening for unspecified cardiovascular conditions (code V81.2).
- Glucose: 1 time per year (each 365 days) for someone without pre-diabetes --Or 2 times per year for someone with pre-diabetes. The screening test must be ordered with the diagnosis code for special screening for Diabetes mellitus (code V77.1).
- PSA Screening: 1 time every year (365 days) for age 50 years and over for special screening for Malignant Neoplasms, prostate (code V76.44)
- Occult Blood Screening: 1 time every year (365 days) for age 50 years and over with no specific diagnosis code required.
Any other test that may be considered screening may NOT be covered by Medicare. This federal program normally only pays for tests that are considered medically necessary based on signs and symptoms given in the form of a diagnosis code to the lab. A Medicare patient may be held personally responsible for payment of these tests. In that case you will be asked to sign a form known as an ABN (Advanced Beneficiary Notice) Form if the test being ordered does not meet requirements to be considered medically necessary. A choice is given to accept this responsibility or to not have the test performed. It is important to take advantage of the above benefit for screening that IS allowed.
Prevent Medical Errors - How You Can Help
Joint Commission’s 2008 National Patient Safety Goals
This website shows what the goals for patient safety are for 2008 as established by the accrediting body for hospitals, the Joint Commission.
Among these are:
- Improving the accuracy of patient identification
- Encouraging patients’ active involvement in their own care
- Improving hand-off communication
Patient and family involvement in your care is encouraged to help prevent medical errors that my harm you. You can ensure that health care providers are complying with procedures such as patient identification. Whenever a sample is taken from you, assure that labeling of your sample includes your first and last names, your date of birth and the date and time that the sample was obtained. In some cases, as for a culture, the site of the culture taken must also be shown so that all of the proper procedures for identifying a cause of infection can be performed.
Information about laboratory testing can be found at the following sites:
LAB TESTS ONLINE – General information for the public about many lab tests.
www.labtestsonline.org/index.html
American Society for Clinical Laboratory Science (ASCLS) – Consumer Laboratory Information
http://www.ascls.org/labtesting/index.asp