Interpretive comments on clinical biochemistry reports.

I n the February issue of the journal, Sandle discussed current practice and future challenges in the management of external quality assurance in relation to clinical biochemistry, highlighting the need for an audit cycle of continuous improvement. One of the important areas touched upon was the quality assurance of interpretive comments on biochemistry reports; it was suggested that in the future individual participation in external quality assurance schemes of interpretive comments ‘‘may become a contractual rather than a professional obligation’’. There is wide variation internationally and within the UK with regard to the extent to which individualised narrative interpretive comments are provided on biochemistry reports. Most biochemistry reports leave the laboratory without comment, or with only computer generated comments according to predetermined rules. However, the provision of individualised narrative comments on at least some biochemistry reports is part of routine practice in many laboratories. The objective is to aid clinicians in the interpretation of complex data, and comments will probably be of particular value when dynamic or uncommon tests are reported, where significant abnormalities are present, or where analytical or preanalytical factors (often not fully appreciated by the clinician) may impinge on the interpretation of the results. Several studies have described this interpretive process and indicated its value, although there is little evidence of improved patient outcomes. The absence of common agreed international standards for working in this area has given rise to debate about the balance between the benefits and risks of providing written interpretive comments on biochemistry reports. In some laboratories, few if any individualised interpretive comments are provided, because of concern about the dangers of providing inappropriate advice in the absence of complete clinical information. A secondary concern is that providing such comments may delay the release of results by the laboratory to the detriment of patients, although results can be released when analytically validated, with the addition of individualised comments soon afterwards and before the release of a final report. In laboratories that choose not to provide written narrative comments, the interpretation of results is often still a crucial part of the laboratory service, but is provided at the bedside or by dialogue with clinicians. The advantage of this approach is that additional information to that provided on laboratory request forms may allow more accurate and appropriate interpretation of results.