How Useful Are CBC and Reticulocyte Reports to Clinicians?
How Useful Are CBC and Reticulocyte Reports to Clinicians?
We surveyed 1,353 attending and 689 house staff physicians of the University Hospitals of Cleveland to ascertain the parameters of the CBC, leukocyte differential, and reticulocyte reports perceived as useful in clinical practice. The response rate was 33% for attending and 22% for house staff physicians. Only 4 of 11 parameters routinely reported in the CBC battery were selected as frequently or always useful by more than 90% of physicians: hemoglobin, hematocrit, platelet count, and WBC count. Among primary care physicians, the mean cell volume also attained this level of usefulness for the evaluation of anemia. There were no differences between academic physicians and community physicians in the use of RBC indices; however, physicians who had been in practice for fewer than 10 years indicated higher use of the red cell distribution width than physicians practicing for more than 10 years. Most physicians prefer differentials reported as percentages rather than absolute counts. Among physicians who monitor reticulocyte counts, the immature reticulocyte fraction is not widely used. Our results indicate that many physicians do not use much of the data provided in routine CBC/differential and reticulocyte reports. Some modifications of report formats may facilitate physician perception of hematology laboratory results.
The CBC count, leukocyte differential count, and reticulocyte count are time-honored hematology laboratory tests with demonstrated clinical usefulness. Originally performed by manual methods, these tests are gradually being supplanted by automated technology. Concurrent with these changes in methods, laboratory computerization has emerged and dramatically changed the way in which laboratory results are reported and transmitted to clinicians. As a consequence of these dynamic changes in laboratory hematology, CBC, differential, and reticulocyte count reports have tended to become longer and more complicated. Factors that may contribute to the report complexity are the following: (1) long-standing traditions in laboratory hematology, (2) the routine inclusion of more hematologic parameters and indices that are produced by automated hematology analyzers, and (3) the belief that more is better. As a result, many physicians might be receiving more data than they want or find useful for the management of their patients. Although speculative, it is conceivable that excess data that are not useful to clinicians might actually impede their perception and comprehension of essential data and contribute to errors in medical judgment.
The purpose of this study was to ascertain which components of the CBC, differential, and reticulocyte count reports issued by the Core Laboratory of the University Hospitals of Cleveland (UHC), Cleveland, OH, are perceived as useful in clinical practice. Understanding the clinical usefulness of laboratory data might suggest changes in laboratory report design and lead to more effective communication of laboratory information to clinicians.
Abstract
We surveyed 1,353 attending and 689 house staff physicians of the University Hospitals of Cleveland to ascertain the parameters of the CBC, leukocyte differential, and reticulocyte reports perceived as useful in clinical practice. The response rate was 33% for attending and 22% for house staff physicians. Only 4 of 11 parameters routinely reported in the CBC battery were selected as frequently or always useful by more than 90% of physicians: hemoglobin, hematocrit, platelet count, and WBC count. Among primary care physicians, the mean cell volume also attained this level of usefulness for the evaluation of anemia. There were no differences between academic physicians and community physicians in the use of RBC indices; however, physicians who had been in practice for fewer than 10 years indicated higher use of the red cell distribution width than physicians practicing for more than 10 years. Most physicians prefer differentials reported as percentages rather than absolute counts. Among physicians who monitor reticulocyte counts, the immature reticulocyte fraction is not widely used. Our results indicate that many physicians do not use much of the data provided in routine CBC/differential and reticulocyte reports. Some modifications of report formats may facilitate physician perception of hematology laboratory results.
Introduction
The CBC count, leukocyte differential count, and reticulocyte count are time-honored hematology laboratory tests with demonstrated clinical usefulness. Originally performed by manual methods, these tests are gradually being supplanted by automated technology. Concurrent with these changes in methods, laboratory computerization has emerged and dramatically changed the way in which laboratory results are reported and transmitted to clinicians. As a consequence of these dynamic changes in laboratory hematology, CBC, differential, and reticulocyte count reports have tended to become longer and more complicated. Factors that may contribute to the report complexity are the following: (1) long-standing traditions in laboratory hematology, (2) the routine inclusion of more hematologic parameters and indices that are produced by automated hematology analyzers, and (3) the belief that more is better. As a result, many physicians might be receiving more data than they want or find useful for the management of their patients. Although speculative, it is conceivable that excess data that are not useful to clinicians might actually impede their perception and comprehension of essential data and contribute to errors in medical judgment.
The purpose of this study was to ascertain which components of the CBC, differential, and reticulocyte count reports issued by the Core Laboratory of the University Hospitals of Cleveland (UHC), Cleveland, OH, are perceived as useful in clinical practice. Understanding the clinical usefulness of laboratory data might suggest changes in laboratory report design and lead to more effective communication of laboratory information to clinicians.