The out-of-hours clinical laboratory tests in most hospitals in Nigeria are not effectively utilized for the intended purpose due to the high rate of inappropriate test ordering and abuse of call duty policy.
Gaps in understanding by young clinicians, gaps in communication from laboratorians and non-utilisation of current technology also make this all important medical service ineffective.
These observations were made by Prof. Hassan Salihu Isah of Department of Chemical Pathology, Ahmadu Bello University Teaching Hospital, Shika, Zaria in a valedictory lecture he delivered to mark his official retirement after serving the University for 46 years.
Prof. Isah was the first non-medical to be appointed a Consultant by Ahmadu Bello University Teaching Hospital in 1987.
The lecture, entitled “Out-of-Hours Clinical Laboratory Tests in Nigeria: Are They Redundant?”, said it all about clinical laboratory tests which remain crucial in medical decision and therapeutic intervention during real medical or surgical emergencies worldwide.
Out-of-hours clinical laboratory tests in Nigeria is the usual practice of clinical laboratories to be involved in the provision of diagnostic testing services after the normal closure of work at 4.00pm.
The practice is global, and the aim is that clinicians, who encounter patients with acute and life threatening emergencies, need to have access to this service in order to make immediate medical decisions and take prompt action.
The retiring distinguished professor, who listed strategies for effective utilisation of clinical laboratory test results, said, however, that such clinical activities were not redundant.
Explaining the factors responsible for this anomaly, Prof. Isah said that the present arrangement in all the hospitals was that laboratory scientists on call duty sleep in the hospitals.
He said it was obvious that the requesting clinicians in such tertiary hospitals take advantage of the sleeping-in policy to order numerous test requests that are not in tandem with the actual clinical emergencies during call duty hours uncontrollably.
The retiring professor hinged his assertion on the call duty data obtained from AKTH, UCH, OAUTH, UBTH, JUTH, UNTH, UATH, UMTH and FMCO, which he compared with the data from ABUTH from January to June, 2022.
He went further to explain that the majority of the requesting clinicians were usually young trainees such as house officers and junior residents.
This, according to him, was because the coverage of laboratory medicine during their undergraduate programmes is often inadequate and many do not cover the peculiarities of clinical laboratory tests during normal and call duty hours.
“It is also possible that adequate and appropriate instructions are not passed to the young doctors by the seniors due to heavy schedules coupled with inadequate staff,” he said.
Prof. Isah observed that a lot of laboratory test results were being generated both for normal and call duty hours by the laboratory scientists, saying that the consultants in the laboratory must be passionate in ensuring rational test ordering and result utilization.
This, he further said, could be achieved by attendance at ward rounds, clinics, theatre sessions as well as actually being in the laboratory during call hours as he was involved from time to time in those days.
He said that laboratorians must take necessary steps and strategies to ensure that the clinical laboratory data were efficiently and effectively utilised.
Prof. Isah stressed that for the services of laboratorians to be relevant in patient management at any time, the data produced must be of good quality, clinically useful and timely; and that the data must provide similar information at lower cost.
In addition, he said that the data must provide useful information not available by other means and the generation of the data must be at lower risk to the patient.
He also canvassed for an urgent need for the formation of multidisciplinary committees and teams between clinicians, laboratorians and other healthcare providers for optimal utilisation of test results to achieve better patient outcomes.
With the present level of ICT awareness, there is golden opportunity for improved patient care online, as it should be possible for the laboratorian to collaborate and consult within the laboratories, clinics, wards, theatres and units, upload clinical laboratory information to facilitate utilization of services, he said.
He also pointed out that all laboratories in all teaching specialist hospitals and medical centres were overdue for installation of internet and establishment of LIMS and HIMS, saying the present scenario in some hospitals where relations of patients were seen moving from wards to the laboratories for results of tests was not acceptable.
