With patient experience emerging as one of the most critical aspects of healthcare delivery, the role of everyone in the whole eco-system becomes increasingly relevant. This entails critically examining the role played by those not directly involved in patient care, such as the diagnostic labs.
A paper presented by The American Society for Clinical Laboratory Science (ASCLS) reiterates the importance of clinical laboratory services in ensuring optimal patient outcomes and patient centered care. By providing the evidence needed for clinical decision making, laboratories have a crucial role to play in patient care.
In a fully efficient healthcare environment, lab heads can inform the physicians on the effectiveness of various medical tests based on specific clinical conditions. This in turn has a bearing on patient management and satisfaction.
By providing accurate tests results or advising the physicians on the relevance of a diagnostic procedure, the lab can help avoid unnecessary tests and the costs associated with them, thus reducing the time spent at the hospital. This results in better efficiency and patient experience.
When labs impact patient outcomes
An academic report on ‘The Laboratory’s Role in Assessing Patient Outcomes’ cites the example of a teaching hospital in US, where there were discrepancies in the blood drawing procedure for therapeutic drug monitoring. There were inconsistencies between the actual time of drawing blood by the concerned nursing staff and the reported time of drawing it. This affected the administration of drug and its concentration levels in the blood, leading to toxic reactions in the patient. What’s worse, there was also a delay in identifying the toxic levels because specimens were tested only once a day and turnaround time could be as long as 36 hours.
When the problem was identified, the hospital put in a place an inter-departmental group to streamline the process. They instituted a more efficient system for documenting sample collection time, interpreting samples and administering the drug. New guidelines were rolled out for the lab staff, leading to major changes in the way the hospital lab functioned and communicated with the caregiving staff.
While studies such as the one conducted by Abbott and IPSOS, indicate that an average of 60% patients surveyed are willing to pay for additional tests and more detailed lab reports, perceptions of unnecessary tests, adverse test reactions or clinical delays obviously impact patient experience and therefore hospital reputation. So labs have a significant part to play in the overall healthcare delivery by ensuring that testing processes are efficient and need-based and the results, reliable.
Having an efficient system in place
But how can labs play this enhanced role? In the example cited above, the hospital in question set in place ‘intra-laboratory’ and ‘extra-laboratory’ process improvements.
Under intra-laboratory measures the lab increased the frequency of testing to provide more accurate reports. It also began to offer pharmacy consultation services to provide accurate analysis of drug levels and sample collection time. A more efficient documenting system was also put in place.
The extra-laboratory processes included the introduction of new nursing guidelines regarding the collection of specimens, educational programmes on lab testing methods and a system for alerting physicians on toxic drug levels. Through these changes, the lab became an integral part of the whole healthcare delivery system.
As the report points out, it is increasingly necessary for labs professionals to address questions regarding patient outcomes based on the time and cost of testing, laboratory quality parameters and the cost of setting up such parameters. It is also important for laboratory managers to use tools that study lab-derived data on patient outcomes. Such tools help in clearly understanding how different aspects of the lab testing process affect the patient healthcare outcomes.
The ASCLS paper offers some suggestions on how labs can enable better healthcare delivery. These include:
- Monitoring patient nutrition
- Ensuring effective medication
- Observing and alerting for drug side effects
- Identifying causes for infection
- Determining effective antibiotic therapy
- Monitoring the effectiveness of therapies for diseases like cancer
- Offering real time clinical decision support
Much of these entail proactive participation and communication at the lab leadership levels. As senior pathologists at a Health Forum held in Chicago three years ago agreed, all stakeholders, particularly the hospital and lab leadership, should recognise the importance of diagnostic labs. Khosrow Shotorbani, noted advocate for increasing the role of the lab, says that lab leaders should reduce jargon in their communication with hospital leadership and be open to looking at their internal processes from a patient centric point of view. On the other hand, the hospital leaders should also ensure labs are not commoditised and treated as partners in key hospital decisions.
Getting down to the core diagnostic process
The lab’s effectiveness ultimately depends on the core diagnostic processes it follows and the accuracy of its results. A robust diagnostic system requires closely studying healthcare trends and applying new scientific information and tools to get accurate testing results.
An example of how small factors can affect lab results can be seen in instances of biotin interference.
Lab professionals especially in US recently had been noticing a peculiar trend of skewed test results, particularly in endocrine function tests. It turned out that the causative factor behind these was the interference of biotin, the water-soluble Vitamin B7. The increased use of vitamin supplements, particularly of Vitamin B7, was leading to a higher presence of biotin in testing samples. As a result, assays or investigative procedures in many hospitals and diagnostic labs were getting affected by its interference.
The fact is that many diagnostic procedures that study endocrine functions or even detect conditions such as AIDS, make use of biotin, a common factor in many molecular tests. But biotin levels in excess, due to supplementary intake or other exogenous reasons, can tilt the balance, resulting in skewed results with serious implications for patient safety.
So, the need was for an effective new process or tool to control the biotin effect during the testing procedure. A study conducted by Abbott showed that by efficiently assessing a testing method’s susceptibility to biotin interference and accordingly using the right chemical components, it is possible to do away with the biotin effect and arrive at accurate test results.
But for such methods to be implemented, awareness needs to be spread among lab technicians and other healthcare professionals. Labs can play a more critical role in impacting healthcare outcomes by strengthening their leadership and proactive contributions to healthcare systems and transforming their processes by adopting new diagnostic tools and innovations. These steps will help labs become key partners in healthcare delivery.
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