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A survey of laboratory practice in the clinical authorization and reporting of results

Background: The aim of this survey was to determine the practice of authorization and reporting of results in clinical biochemistry laboratories in the UK. Method: Questionnaires were distributed to the heads of clinical biochemistry departments through the National Audit Committee of the Association of Clinical Biochemists. The standards surveyed were based on guidelines for the reporting of results produced by the Royal College of Pathologists and the relevant Clinical Pathology Accreditation standards. Results: Completed questionnaires were received from 137 laboratories. Workload ranged from 15 000 to 750 000 requests per annum (median 276 883). Most laboratories (98%) release results electronically to at least some wards in real-time. Areas where difficulties were identified included identifying requests that had posed specific questions and access to clinical information at the authorization stage, recording clinical advice given, and ensuring comments remained attached to printed reports or were on the same screen on computer reports. All but six laboratories had consultant advice available, including out of hours, but only 17% had an arrangement for clinical authorization to occur out of hours. Conclusion: Only 45 laboratories (33%) were able to achieve 100% compliance with the standards that currently exist, but many others showed evidence of good practice. The practical obstacles still to be overcome include limitations in the capabilities of laboratory computer systems, the lack of accessible electronic clinical records, the difficulties of covering work out of hours and insufficient appropriately trained staff.