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Nationwide Survey on Knowledge, Attitudes, and Practices regarding Reference Interval Utilization in Clinical
Vivek Pant1,2, Santosh Pradhan1,2, Dipesh Tamrakar2,3
1Department of Biochemistry, Samyak Diagnostic Pvt Ltd, Kathmandu, Nepal.
Background:
Reference intervals (RIs) are critical for accurate clinical decision-making, yet many laboratories rely on manufacturer-provided RIs without local validation. This study assessed the knowledge, attitudes, and practices (KAP) of clinical laboratories in Nepal regarding RI utilization, highlighting challenges and opportunities for standardization in alignment with ISO 15189:2022 accreditation.
Methods:
A nationwide cross-sectional KAP survey was conducted among 56 laboratory professionals. Data were collected via an online questionnaire, covering demographics, RI knowledge, current practices, challenges, and attitudes toward national standardization. Descriptive and inferential statistics (chi-square, Fisher's exact tests) were used for analysis.
Results:
While 71.4% of respondents correctly defined RIs as the 2.5th-97.5th percentiles, 28.6% held misconceptions. Most laboratories relied on manufacturer-provided RIs (87.5%) or published literature (67.9%). Key challenges to derive one's own RI included method variability and recruiting reference individuals. Accredited labs (ISO 15189) demonstrated better knowledge of RI (93.3% vs. 63.4%, p=0.032) and higher confidence in using current RI (26.7% vs. 7.3%, p=0.047). Strong interest existed in national RI standardization (92.9%) and training (85.7% preferred hands-on workshops).
Conclusions:
This survey of higher tier clinical laboratories in Nepal reveals that while these laboratories generally understand the importance of reference intervals, significant gaps in practice and standardization remain. The findings highlight an urgent need for inclusive strategies that also address the unique constraints of smaller, widespread laboratories, which perform a large proportion of routine testing in the country. The intense interest in a national program presents an opportunity to improve. Multicenter studies and RI validation integration into accreditation are needed to improve diagnostic accuracy.
