Autoverification in the Clinical Hematology Laboratory

As analytical methods in automated laboratories become faster and more efficient, the rate-determining step for the release of information to the patient record is no longer the generation of data, but our ability to process and manage data. Medical technologists are responsible for numerous complex and integrated tasks in the clinical laboratory that require subjective or interpretive skill. In addition to these necessarily manual tasks, however, many of the decisions made by medical technologists involve numerical calculations, comparisons, or Boolean algorithms, which are readily adaptable (and more consistently and reliably performed) by automated methods. Therefore, one can design automated systems that exactly recapitulate decision algorithms carried out manually by technologists, and these systems can be further expanded to include decision logic that cannot be practically deployed by manual methods.23-26 Autoverification is almost certainly underutilized in the clinical hematology laboratory community; indeed, most published information regarding autoverification appears in publications aimed at administrators and technologists. It behooves clinical pathologists and laboratory directors to become familiar with the concepts of autoverification as part of optimizing information management in the clinical laboratory.

Most laboratory information system (LIS) vendors offer autoverification software that allows for user-defined options regarding specific ranges and values acceptable for autoverification, mirroring manual verification steps that exist under the laboratory's policy. The deployment of these applications provides for the auto-release of results to the patient record in real time, if established criteria are met. Criteria are set for autoverification (see Table 7-1) based on pre-defined ranges for each parameter in the CBC, and the type of delta checking (comparison of current and previous results for the same analyte for a given patient) used for that parameter. Such a system currently results in autoverification rates between 72 and 84 percent in our laboratory.

The delta check criteria used in the set-up have become more sophisticated than most manual criteria used because computers are able to delta check previous results using standardized criteria. LIS vendors offer many sophisticated kinds of delta checking, including percentage difference from current to previous result over a user defined period, or absolute value between current and previous result, with or without proration.

The avoidance of posting errant results to the patient chart is an overriding concern with the design of autoverification systems. Strategies like the one outlined in Table 7-1 allow the autoverification of abnormal CBC results, but keep a tight delta check around the MCV and RDW. This is done so that misidentified samples can be detected. Due to the stability of the MCV and RDW within a given patient, the hematology laboratory is often the first to suspect a misidentified specimen, and is then able to alert other clinical areas that have received specimens from the same draw. Autoverification software packages offered by most LIS vendors have user designed options that suppress autoverification of results from other parameters within the blood survey when a delta fail, critical value, or out of range result is encountered. Configuration of the autoverification criteria as a strategy brings added value to the design.

Table 7-1. Typical instrument-driven criteria for autoverification of complete blood count results (not including the leukocyte differential count)_

Test Range Delta Check Percent Delta Check Value

Table 7-1. Typical instrument-driven criteria for autoverification of complete blood count results (not including the leukocyte differential count)_

Test Range Delta Check Percent Delta Check Value

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  • Gavino
    How to validate autoverification?
    6 years ago
  • giovanna
    What is responsible for autoverification of results in a laboratory?
    7 months ago
  • Tanja
    How to set up medical laboratory autoverification?
    5 months ago

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