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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

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Volume 49, Issue 7


Closing the brain-to-brain loop in laboratory testing

Mario Plebani / Giuseppe Lippi
  • Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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Published Online: 2011-06-13 | DOI: https://doi.org/10.1515/CCLM.2011.617


The delivery of laboratory services has been described 40 years ago and defined with the foremost concept of “brain-to-brain turnaround time loop”. This concept consists of several processes, including the final step which is the action undertaken on the patient based on laboratory information. Unfortunately, the need for systematic feedback to improve the value of laboratory services has been poorly understood and, even more risky, poorly applied in daily laboratory practice. Currently, major problems arise from the unavailability of consensually accepted quality specifications for the extra-analytical phase of laboratory testing. This, in turn, does not allow clinical laboratories to calculate a budget for the “patient-related total error”. The definition and use of the term “total error” refers only to the analytical phase, and should be better defined as “total analytical error” to avoid any confusion and misinterpretation. According to the hierarchical approach to classify strategies to set analytical quality specifications, the “assessment of the effect of analytical performance on specific clinical decision-making” is comprehensively at the top and therefore should be applied as much as possible to address analytical efforts towards effective goals. In addition, an increasing number of laboratories worldwide are adopting risk management strategies such as FMEA, FRACAS, LEAN and Six Sigma since these techniques allow the identification of the most critical steps in the total testing process, and to reduce the patient-related risk of error. As a matter of fact, an increasing number of laboratory professionals recognize the importance of understanding and monitoring any step in the total testing process, including the appropriateness of the test request as well as the appropriate interpretation and utilization of test results.

Keywords: brain-to-brain loop; clinical risk management; extra-analytical indicators; patient safety; quality specifications; total error

About the article

Corresponding author: Prof. Mario Plebani, Department of Laboratory Medicine, University-Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy Phone: +390498212792, Fax: +39049663240

Received: 2011-03-08

Accepted: 2011-03-08

Published Online: 2011-06-13

Published in Print: 2011-07-01

Citation Information: Clinical Chemistry and Laboratory Medicine, Volume 49, Issue 7, Pages 1131–1133, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2011.617.

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