The Test - Lundberg's Loop
Reviewer: Richard E. Horowitz, M.D. (see Reviewers page)
Revised: 15 June 2013, last major update June 2013
Copyright: (c) 2012-2013, PathologyOutlines.com, Inc.
- The fundamental product of pathology and laboratory medicine is information based on the performance of tests
- In order to plan, organize and control lab operations the "test" must be the central element of concern
- George Lundberg, MD expanded the concept of a "test" from merely an analysis to the "brain-to-brain loop" wherein a "test" really commences when a clinician has a problem and is not completed until the problem is solved
- The terms "pre-analytic", "analytic" and "post-analytic" have been used to separate the phases of testing and to identify those phases which are clearly the responsibility of the laboratory and those that occur outside of the laboratory and are outside its control
- Regardless of where in the testing cycle a defect exists, or an error occurs, if the clinician's problem is not solved, it is considered a "lab error"
- Therefore, when designing (or assessing) laboratory operations, it is necessary to scrutinize all components of the "loop"
- In general, the analytic phase which is clearly under the control of the laboratory is well controlled by the laboratory's quality assurance and performance improvement systems and causes few slip-ups; the other phases of the "loop" are where errors most often occur and where the laboratory must take ownership and responsibility
- In this section the various sub-systems, or phases, which comprise the brain-to-brain loop are described
The Brain-to-Brain Loop (After Lundberg, see references below)
- A physician has a problem
- The physician thinks of using a test to help solve the problem
- A test is ordered, verbally or in writing
- The test request is entered into an information system (HIS or Web)
- The requisition is transferred to the laboratory computer
- Laboratory computer generates pick-up lists, work lists, billing data, checks for duplicate test orders, duplicate names and checks for appropriateness of order (in terms of Admitting Diagnosis or ICD codes)
- Phlebotomist or nurse obtains specimen and sends it to the laboratory
- Specimen is triaged in laboratory central receiving area
- Test is performed and verified (the old concept of what a test is)
- Pathologist interprets test as needed
- Test results are transferred to the originating information system
- Test results are available at the nursing station (paper or CRT)
- Test results are placed in patient chart and sent to physician's office
- Physician uses the test results to help solve the problem
- Note: Although the laboratory has direct control only over items 6 to 10, it is responsible for the entire process and any error anywhere in this sequence is considered a lab error
End of Laboratory Administration > Operations > The Test - Lundberg's Loop
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