Several common hospital conditions may affect laboratory results without such alteration being recognized by the physician. These include intravenous fluids running at the time the test specimen is drawn, the effect of dehydration, the effect of heparin flushes on some tests, the effects of various medications, and in certain cases the administration of medication at a time different from that expected or recorded. The last item refers to the common situation in which several patients are scheduled to receive medication at the same time (e.g., 8 A.M.). Although administration to each may be charted as being the same time, the actual time that any individual receives the medication may vary significantly.

Another frequent problem is defective communication between the physician and the laboratory. In some cases this takes the form of incorrectly worded, ambiguous, or illegible orders. Nursing or secretarial personnel can easily misinterpret such orders and relay them incorrectly to the laboratory. Nonstandard test abbreviations or acronyms created from the names of new tests not familiar to nursing personnel also cause difficulties. In some cases the physician should supply at least a minimal amount of pertinent clinical information to obtain better service. This information is most vitally needed in the microbiology department. The microbiology technologist must know from what area the specimen was obtained, exactly what type of culture is desired, and especially, whether any particular organism is suspected so that special growth media or special handling may be employed if necessary. Basic clinical information is even more essential to the surgical pathologist and the radiologist. The surgical pathologist must at least know where the tissue specimen originated, and both the pathologist and radiologist can do a much better job providing an answer to the clinician if they could only know what the clinician’s question is (i.e., for what reason is he or she requesting the study).

A word must be said about stat orders. Stat means emergency to the laboratory. Someone must stop whatever he or she is doing and perform the stat analysis immediately, possibly having to obtain the specimen first. After analysis the report must be delivered immediately. During this time that laboratory person may not do any other work. Stat tests result in great decrease of laboratory efficiency and cost effectiveness. The most efficient and least expensive way to perform tests is to analyze several patient specimens at the same time, so that the initial setup and quality control portions of the test need be performed only once and all specimens can be incubated simultaneously. Extra speed is obtained when a test is ordered stat, but results for everyone else are delayed. Unfortunately, many stat requests, sometimes even the majority, are ordered for reasons other than a true emergency need for the result. In some cases the order originates fromnursing service because someone neglected to send a requisition for a routinetest to the laboratory. In other cases the order is made stat because of convenience to the physician or the patient. Stat orders for these purposes at best are inconsiderate, wasteful, and disruptive. The physician should consider whether some other action-producing order category could be substituted, such as “as soon as possible.” If the actual problem is that of unacceptable turnaround time for routine tests, this is a matter to be discussed with the laboratory director rather than evaded by stat orders.