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La Rivista Italiana della Medicina di Laboratorio 2020 Marzo;16(1):34-43

DOI: 10.23736/S1825-859X.20.00045-6


language: Italian

The Laboratory Medicine consultation in Italy


SIPMeL, Castelfranco Veneto, TV, Italia

BACKGROUND: The Laboratory Medicine consultation in Italy is not well known. The present work surveys the state of art of Laboratory consultation in Italy with regard to the types of topics and callers, the organization of the service and the time spent by the Laboratory team, and the barriers and the critical success factors.
METHODS: A 10-items Questionnaire was administered to 20 Laboratory professionals between 2016 and 2018. The questions were addressed to the number of consultations per day, the organization of the service including any filters, types of clinicians and frequent flyers, differences among different types of clients, mode of contact, reasons of consultation, more interested disciplinary areas, proactive actions for promoting consultation. Moreover, some information was required for determining size and type of the Laboratory and a free text section for comments was available. The participants were selected on a basis of direct relationship but with the goal of a representative group of the majority of Italia Regions (15 out of 20), of the different type - public (90%) or private (10%) - of trusts, of the different size of Laboratories (15% under a million tests/year; 15% over 10 millions tests/year), and of the different type - general (85%) or specialized (15%) - of Laboratory.
RESULTS: All surveyed Laboratories practiced consultancy activities, with an average number of consultations per day of 1 for every 27 clinicians (range from 10 to 50) and 1 for every 82 patients (from 10 to 400) served. The time spent on this activity was estimated between 5% and 14% of the team’s total working time. In only one case there was a formalization of consultancy (5%); in 15% of cases there was a filter (dedicated telephone number). The callers were mainly Primary Care Physicians (PCPs) or free-choice pediatricians, who represent 60-80% of consultants in 95% of cases. Frequent flyers were PCPs in 30% of cases, Hospital doctors in 50% and patients in 20%. The contact tools were telephone (60-80%), e-mails (20-40%) and direct contact (<5%). The main reasons for the consultation were the interpretation of the results (40%-100% of requests); suggestions on the choice of the initial best test of the diagnostic path (30-60%) or of the subsequent sequence (15-30%); advice on treatment, for the path and monitoring as well as therapy (20-60%). PCPs and free-choice pediatricians required treatment recommendations more frequently than Hospital doctors. The preferred topics were, in generalist laboratories, infectious diseases (80%), hematology (80%), coagulation (70%), endocrinology (70%), autoimmunity (60%) and clinical chemistry (toxicology, biochemistry, proteins 40%). In specialist laboratories there was a consultancy activity in 100% of cases for infectious disease and coagulation and 80% for allergy and hematology. The critical success factors were the management of a specialist clinic (70%), the specialization of the laboratory (20-40%) and proactive activities such as commenting (90%), direct communications to the clinicians (70%), educational meetings (60%) and added-value activities in reporting (30%). The main barriers to laboratory consultancy were the lack of knowledge by potential users, a supposed laboratory expertise of clinicians and, last but not least, the laboratory’s reluctance to provide consultancy.
CONCLUSIONS: The research shows, for the first time in detailed terms, that in Italy consultancy represents an important laboratory activity, in quantitative terms (number of clinicians and patients served every day; time dedicated by the team), for the areas concerned (mainly specialist ones), and for clinical efficacy (number of frequent flyers), and what are the barriers and critical success factors. The consultancy should be a parameter of the performance of the Laboratory and included among the quality indicators.

KEY WORDS: Laboratory medicine; Referral and consultation; Quality indicators, health care

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