Lack of uniform reporting of laboratory results can cause confusion among caregivers. At the Providence Veterans Affairs Medical Center, residents rotate from four hospitals in Brown University's medicine program. Residents document the latest laboratory results in slightly different formats. Knowing what result is in what space on a "grid" is often intuitive.

In progress notes, chemistry values are placed in a grid with seven niches; complete blood counts are placed on one with four niches (Figure 1). We have seen laboratory results displayed in every possible arrangement. Glucose values are usually, but not always, shown between the legs on the chemistry grid, and platelet values are shown in a similar position on the hematology grid.

View larger version (13K): [in this window] [in a new window]   Figure 1. Grid formats for laboratory results. Top. The present system. An asterisk indicates the various observed locations for potassium values. Bottom. The proposed system for laboratory results. BUN = blood urea nitrogen; Cl = chloride; CO2 = carbon dioxide; creat = creatinine; Hct = hematocrit; Hgb = hemoglobin; K = potassium; Na = sodium.

Recently, a platelet count was mistaken for a glucose value in a patient with diet-controlled diabetes. An attending physician wrote "now with increased glucose in the 260 range" when the patient's blood sugar was 122 g/dL and the platelet count was 268 000. Consequently, the intern ordered an oral hypoglycemic. The patient's glucose level ranged from 70 to 100 mg/dL for the remainder of his hospitalization. When seen in follow-up, the patient reported that he had stopped the oral hypoglycemic after reading about its side effects in the popular press.

Although expression of laboratory values on a grid may be expedient, the data can be misconstrued. We have proposed that a uniform grid style be instituted for hospitals within the Brown system (see Figure 1). Nationwide uniformity might avert a mistake similar to that described here when physicians move from one hospital to another.