Thursday, April 28, 2005

Results of a Survey of Prothrombin Time Testing Practices in the Pacific Northwest, 2004

Shahram Shahangian and Kathy LaBeau.

Coagulation and bleeding problems are associated with substantial morbidity and mortality, and certain inappropriate prothrombin time (PT) testing practices may lead to such complications.

To evaluate reported PT testing practices in the US Pacific Northwest and to assess why certain laboratory testing guidelines are not followed.

Laboratory sites in the Pacific Northwest Sentinel Laboratory Monitoring Network performing the PT test were identified and targeted to receive a questionnaire that enquired if certain specific PT testing practices were followed by them and if not, why. We used the Washington Medical Test Site database and licensure application forms for laboratories in Washington, and the CLIA (OSCAR) database of laboratories performing proficiency testing for laboratories located in Alaska, Idaho and Oregon. Questionnaires were mailed to all of these 591 laboratories in January 2004. By March 2004, 297 completed questionnaires were returned, resulting in an overall response rate of 50%. There were 152 point-of-care respondents (response rate, 46%), 117 hospital respondents (response rate, 59%), and 28 independent laboratory respondents (response rate, 47%). The outcome measure was prevalence of reported PT testing practices, and the study did not involve any intervention.

Of those responding, a minority (22%46%) stated using voluntary practice standards to select their reagents, to select citrate concentration, to develop policies for specimen acceptance/rejection, and to develop policies for checking out new lots of reagents. Of those not using practice standards, 51%60% reported not being aware of them. The following proportions reported using the practices stated below:
having written specimen acceptance/rejection policies for blood collected by venipuncture, 94%;
exclusively using collection tubes with 3.2% sodium citrate anticoagulant, 92%;
establishing their own patient mean of normal, 95%; and
verifying their reference range when implementing new lots of reagents, 92%.

Interventions should raise awareness of existing laboratory practice guidelines.

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