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AN AUDIT OF THE INVESTIGATION REQUEST FORMS SUBMITTED TO CHEMICAL PATHOLOGY LABORATORY IN A TERTIARY CARE HOSPITAL AND ITS IMPACT ON CRITICAL AND ABNORMAL RESULTS COMMUNICATION WITH CLINICIANS

Dr. Saman Waqar, Dr. Jawad Shabbir, Dr. Hibbah Jamil

Background: In a tertiary care setup, everyone expects better care and management of the patient. This requires a lot of things. One of them is the provision of full data about the patient to the pathologist on an investigation request form so that a proper communication between the clinicians and pathologists can be developed about the critical results of investigations of the patient if there is any. So an audit has been done of the investigation request forms received in chemical pathological laboratory of Pakistan Institute of Medical Sciences (PIMS), Islamabad, during the period of past three months and the impact of incompletely filled request forms has been estimated on the critical and abnormal results communication with the clinicians. Methods: Data of the past three months was collected from the chemical pathological laboratory of PIMS. Complete and incomplete request forms were isolated. Frequency of each missing information on incomplete request forms was evaluated. Evaluated data was entered on Microsoft Excel sheets. Critical and abnormal results were isolated from results of investigations carried out for collected request forms. Impact of missing information, on request forms, on communication of these critical results was calculated and analyzed by the SPSS version 23. Results: During the period of 3 months about 76,260 investigation request forms were submitted at the chemical pathological laboratory of PIMS. Patients’ name, age and gender were missing on 73,800 (96.77%), 73860 (96.85%) and 74133 (97.2%) request forms respectively. Date was missing on 10260 (13.45%) request forms, ward number was missing on 74163 (97.25%) request forms, bed number was missing on 75012 (98.36%) request forms, clinicians name was missing on 73860 (96.85%) request forms and brief history of the patient was missing on 74910 (98.28%) request forms. Total 204 (0.268%) results were abnormal or critical out of 76260 results for submitted request forms and only 15 (7.35%) out of 204 were communicated other 189 (92.65%) critical results could not be communicated. Only patient’s control number, investigations required and clinician’s sign was there on 100% request forms. Conclusion: The audit of 3 months shows that very important information like patient s’ name, age and gender, bed number, ward number and clinicians’ name was missing in about 96-98%. Date was missing on comparatively less13.45% request forms. Patient’s control number, investigations required and clinician’s sign were there on 100% request forms. Out of 76260 results for submitted investigation request forms, results of 204 investigations were abnormal or critical and needed to be communicated but only 15 could be communicated and other 92.65% critical values could not be communicated due to the missing information regarding ward number, bed number and clinicians’ name on the request forms. These results shows that missing information on investigation request forms have massive impact on the critical or abnormal result communication with the clinicians. Key words: Investigation request forms, Communication, Critical value, Chemical pathological laboratory

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