Acting on significant laboratory results.

The nine steps in the performance of any laboratory test include ordering, collection, identification (at several stages), transportation, separation (or preparation), analysis, reporting, interpretation, and action. 1 Unless the appropriate action occurs, it is as if the cycle had never begun and is, at the most, a tragedy and, at the least, a waste. Several years ago, we coined the phrase "brain-to-brain turnaround time" in which we envisioned a loop such as is shown in the Figure. Anything that interferes with closure of the loop through step 9 leaves an "open loop"—the bane of any decision or information system. 2 We have discovered over many years at several institutions that physicians "want what they want when they want it" and that anything that stands in the way of their prompt and perfect receiving of laboratory results for their patients is perceived as a "laboratory problem or error." Thus, matching responsibility,