Laboratorians are in a unique position to accomplish all three goals, but for one enduring obstacle: They tend to prefer life within the laboratory. However, if laboratorians want to multiply the value of their lab—and indeed, help improve the delivery of care, in general—they'll benefit greatly from stepping out of it.
Fortunately, there are a number of concrete steps that lab leaders can take to proactively engage with professionals beyond the lab. Here, our key opinion leaders offer three ways that laboratorians can collaborate with care teams, reduce waste, improve quality, and magnify the impact of their work.
While laboratorians have strict control over what happens inside the lab, they're often unable to oversee what happens beyond it. Because of this, it's critical for lab leaders to ensure that the professionals outside the lab who order lab tests and administer point-of-care testing are equipped for success. As such, lab leaders should form a team that meets regularly with physicians, nurses, technicians, and the like, to educate them on all manner of testing and ensure ubiquitous compliance.
Robert L. Sautter, PhD, RL Sautter Consulting, LLC, former Director of Microbiology and Point of Care, Carolinas Pathology Group, Charlotte, NC, explains how, as former CLIA medical director at Pinnacle Health System, he organized a two-person point-of-care coordinator team to visit every care site within Pinnacle every month. The team trained competencies with internal medicine residents, technicians, OBGYN professionals, and internal medicine physicians. Sautter himself would visit each site every two months.
"Nurses want to do a great job. Technicians want to do a great job. They don't understand how important it is. Seventy percent of diagnoses rely on laboratory tests," he says, emphasizing that when there's non-compliance, lab leaders should personally intervene and explain guidelines. "They're not laboratorians—this is how we make them laboratorians."
One persistent problem among health systems is the misinterpretation of test results and the over- or under-utilization of testing. Michael Laposata, MD, PhD, professor and chairman of the Pathology Department at the University of Texas at Galveston, explains that many doctors lack the expertise needed to accurately evaluate tests and make confident diagnoses, especially when complex testing is involved. "They don't know enough," he says.
However, Laposata explains that an effective way to combat this issue is for lab leaders to actually come to patient bedsides as part of a diagnostic management team (DMT). "Additional information [that physicians need]," he says,"comes from creating a diagnosis as a team sport. [You should have] an expert on the diagnostic test, an expert maybe in radiology, and then the doctor who's seeing the patient and evaluating them—all are necessary."
While at Vanderbilt, Laposata helped to form six DMTs, which altogether helped to save the university health system an estimated $50 million annually. How? By helping to appropriately select tests and facilitate quick, accurate diagnoses, laboratorians helped clinicians to dramatically reduce waste (choosing a single vitamin D assay, instead of 10, for instance), shorten hospital stays, and improve outcomes—all of which benefited the bottom line.
Even laboratorians who make a habit of getting out of the lab can't be everywhere at once. However, by creating a standard set of testing guidelines for certain disease states, lab leaders can amplify their expertise and generate new value for the health system. Moreover, with clinically effective and cost-efficient protocols in place, lab leaders can help combat the feeling among administrators that labs are a cost center.
Charles Mathews, vice president of Boston Healthcare, explains that, despite notions to the contrary, "The cost of testing is actually money well spent, because relative to the amount of money that gets thrown in empiric therapy... it's a drop in the bucket. But the problem is our leadership at the lab level has not done a good job articulating the value proposition of testing."
The best way for lab leaders to do that, he says, is to, "Actually get out from behind the microscope and work with physicians to create a standardized testing protocol that makes sense. Saying, 'Okay, here's the test we're going to order. Here's what we're going to do with result A, versus result B.'"
For laboratorians who prefer to remain in the lab, immersed in data, it can seem unintuitive to take charge with clinicians and administrators — but in many cases, that's precisely kind of initiative that needs to be taken. Says Mathews: "We need to get out in front of it and say, 'Actually, you can't have every test for everybody, but here are the right ones and here's what you're going to do with the information."
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By Advanced Healthcare Network staff