Autoverification of test results in the core clinical laboratory

Verification of laboratory test results represents the last opportunity to identify errors before they become part of the electronic medical record. Manual verification of test results places significant reliance on the experience and attentiveness of individual observers to identify errors and is vulnerable to errors through omission and neglect. Peer-reviewed publications have documented gains in process efficiency and quality improvement by use of middleware or laboratory information systems to autoverify test results based on pre-defined acceptability criteria. This review evaluates the acceptability of autoverification (AV) as a safe and reliable alternative to total manual review of laboratory test results. AV schemes developed in accordance with international guidelines and standards are applied throughout the laboratory. Careful design of AV systems involves using multidisciplinary teams to develop test-specific decision algorithms, to assist with programming, to verify programming, and validate programmed algorithms prior to use in evaluation of patient test result profiles. Development of test specific decision algorithms makes use of criteria based on instrument messages and flags, quality control status, result limit checks, delta checks, critical values, consistency checks, and patient-related clinical information. Monitoring of the performance of AV parameters, and regular audits of the AV system integrity is recommended in both the literature and guidelines. The potential for gains to process efficiency, error detection and patient safety, through adoption of AV as part of a laboratories quality assurance tool-case, is well supported in published literature.