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By Lauren VanDenBoom

Laboratorians are in a unique position to inform the appropriate use of the testing they provide. In May, hc1 Director of Clinical Affairs, Wes Wong, MMM, MD, joined Quest Diagnostics Senior Medical Director, Medical Affairs, Lee H. Hilborne, MD, MPH, for a webinar hosted by Dark Daily offering Strategies for Laboratory Professionals to Drive Lab Stewardship to Reduce Cost, Eliminate Waste, and Improve Patient Care

They shared the evolution of quality in laboratory medicine and the emergence of laboratory stewardship, offering five key elements for building a successful laboratory stewardship program. 

Laboratory stewardship has a long history

Many years ago, the lab community recognized that quality extended beyond just analytic quality and included both the pre-analytic and post-analytic processes that occur outside the laboratory’s walls. “Opportunity exists to improve quality in all phases of the total testing process from the pre-analytic before the specimen gets to the lab to the analytic to the post analytic. Most opportunities, frankly, exist outside the analytic phase,” said Dr. Hilborne. “The primary focus of lab stewardship really is to get out from the analytic and look at the pre-analytic and post analytic. So how can we do a better job of doing the right test? Well that’s not going to come from improving the quality of our internal process, as sure we’ve got room there, but if we want to have the biggest impact on quality, what we’ve got to do is focus primarily, although not exclusively, on the pre-analytic phase before the specimen frankly ever gets to the laboratory.” 

Laboratory stewardship initiatives are a way to improve quality and efficiency and reduce risk management exposure with fewer errors. They also typically improve payment and reimbursement. Optimal laboratory testing that avoids over- or under-testing improves the patient experience. Reduced care variation improves population health. Prevention of unnecessary test orders (and associated downstream care) lowers healthcare costs. Streamlined clinical decision support improves clinician practice satisfaction.  

Laboratory stewardship can extend beyond curbing overutilization of testing, however. Dr. Hilborne said the COVID-19 pandemic in particular has called attention to the need for programs that will identify underutilized testing, as well, particularly in the management of chronic disease. “We’re going to be doing the right thing for the right patient at the right time,” he said.

“Looking at our laboratory data in an objective way can identify opportunities to close gaps in care,” Dr. Hilborne said. “Using data and integrating it to look at opportunities to provide better care really empowers leaders, especially laboratorians (that’s us) by supporting committees toward creating an appropriate, equitable and efficient health care environment. So there’s a real opportunity here for laboratories to be more in a leadership position now. We should really capitalize on that.

Five essential elements for building a successful laboratory stewardship program

To help laboratorians understand how they can get involved in implementing effective lab stewardship programs, Dr. Wong shared five essential elements for building a successful laboratory stewardship program and how laboratorians could get involved. 

1. A clear vision and organizational alignment

Implementing a laboratory stewardship program is an opportunity for laboratory professionals to drive the change they want to see. It is important, however, that the laboratory’s vision is aligned with that of the organization. They should seek to understand the health system organization and communicate a compelling case for change. “I want to emphasize the critical relationship we have with clinicians, the laboratories, the results and how that drives patient care,” said Dr. Wong. 

2. Skills

An effective team brings multiple colleagues to the table, each with unique skills and abilities, to define, evaluate, and address problems. “As you know, healthcare is full of obstacles and silos,” said Dr. Wong. “Part of this is just relationships and the project management skills necessary to maintain that discipline, stay the course, achieve your outcomes and again create sustainability.”

3. Resources

Any successful program must have the necessary resources to successfully realize its vision. In particular, laboratory stewardship programs need human resources, equipment, supplies and information. 

4. Incentives

Achieving a mission and vision requires an organization to focus on key aspects related to their practice or operation. Given the central role of laboratory medicine in every clinical practice, an effective laboratory stewardship program helps any organization reach its goals and objectives, supporting the mission and realizing the vision.

5. A plan of action

A well-defined plan of action includes a sense of urgency and articulates program objectives, with milestones and metrics. “We need to focus on what’s the problem we’re trying to solve today,” said Dr. Wong. “The problem we’re trying to solve with laboratory stewardship and what’s the data that changes that culture that brings us to the results that makes the team work toward that end. The key here is data. The data will change the culture and change how we do things. You put this in the hands of providers and clinicians and you can affect many changes and lead the change.”

Powering precision health through laboratory stewardship

In 2019, hc1 and Quest Diagnostics launched a strategic collaboration focused on improving the costs and clinical impact of lab testing. Quest Lab Stewardship powered by hc1 empowers health systems to optimize laboratory testing and deliver high-value care. Built with our understanding of the clinical necessities and business realities of providing and paying for care, the solution enables progressive health systems to help improve patient care through better laboratory utilization.

Dr. Wong and Dr. Hilborne’s webinar is now available on-demand. Click here to watch

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