The delineation of a brain-to-brain loop in clinical laboratory testing first published in 1981 has never been more pertinent. Its subsequent development and current application in clinical molecular oncology in 2016 can make all the difference.
This discussion focuses on the factors that drive the ordering of a lab test and the many components thereof, itemizes pre- and postanalytic causes of diagnostic error, and recommends how a laboratory can help ensure the usefulness of the entire process.
Just as a chain is no stronger than its weakest link, a loop that isn’t closed is (obviously) still open.
Technical and laboratory workers tend naturally to define their work by their technical products and procedures, as well they should. In clinical laboratory testing, that tends to be the step called “analysis.”
The success or failure of an “analysis” may well depend upon the pre- and postanalytic phases at least as much as the analysis itself.
In response to a tragic death of a young man in Los Angeles in 1969 because of a failure to recognize and act promptly on a critical laboratory value at the far end of the laboratory testing process, we created the concept of a complete brain-to-brain loop as essential components of any patient-focused clinical laboratory test. In 1981, one of us (GDL) described a brain-to-brain loop for all clinical laboratory testing in an editorial in the Journal of the American Medical Association entitled “Acting Upon Significant Laboratory Results” (JAMA 1981;245:1762–1763, doi:10.1001/jama.1981.03310420052033).
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