Healthcare’s shift to focus on patient outcomes and quality requires laboratory professionals to step up their game and make sure their labs provide value in the new system’s parameters. Laboratory stewardship refers to taking ownership of your lab’s contribution to patient care from top to bottom. One of the cornerstones of laboratory stewardship, and something lab professionals can directly impact, is guiding better test utilization.
Better Test Utilization Is Important in Value-based Care
Laboratory results represent a considerable portion of the objective data in medical records, and that data makes a substantial contribution to critical care decisions. With this in mind, it becomes extremely important to have the appropriate tests ordered with accurate results to ensure proper downstream patient care. Providers use laboratory test results for screening, diagnosis, and disease monitoring, and most test results contribute to a change in diagnosis, therapy, prognosis, or the understanding of disease.
Why Tests Are “Mis-ordered”
There are a multitude of reasons why laboratory tests are “mis-ordered,” ranging from “that’s the way it’s always been done” to pressure from patients to order tests that may not be needed simply because they read about the test on the Internet. Moreover, providers are faced with concerns that if something is overlooked, it will result in malpractice litigation, or worse, patient harm. Past mindset has been to leave no stone unturned, and physicians have been trained in this manner.
Overutilization & Underutilization
It is often assumed that overutilization involves too much repeat testing, particularly in a hospital setting that employs standing orders. Inpatient standing orders are convenient but known to lead to waste. However, studies show that the main problem with overordering occurs at the time of the initial evaluation.
A vital component of early chronic disease care that can save healthcare dollars is the increased utilization of diagnostic lab services. Clinical laboratory testing plays a pivotal role in identifying chronic conditions, accurately characterizing a disease, and helping clinicians devise the most appropriate treatment plans.
Implementing Test Formularies
Using a laboratory formulary, laboratory professionals and pathologists can play the role of gatekeeper and thereby manage their test menus appropriately, contributing their expertise to help advise who can order tests and when. A formulary can be used to identify tests that require laboratory intervention and review.
Testing Cascades as a Utilization Tool
Proper implementation of testing algorithms that cascade through a logical testing sequence based on initial results, developed in tandem with ordering physicians, can eliminate providers having to choose from an overwhelming menu of hundreds of available tests. Laboratory-driven algorithms allow the laboratory to handle the entire cascade or algorithm process with no further input from the provider. These algorithms can be instrumental in making sure that only the appropriate tests are ordered.
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>In an environment that has little room for inefficiency or waste, it becomes imperative that laboratories take a proactive, involved role in making sure that the best tests are ordered and interpreted properly to contribute to our goal of better patient care.
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