Strategies for laboratory professionals to drive laboratory stewardship

Abstract

Appropriate laboratory testing is critical in today's healthcare environment that aims to improve patient care while reducing cost. In recent years, laboratory stewardship has emerged as a strategy for assuring quality in laboratory medicine with the goal of providing the right test, for the right patient, at the right time. Implementing a laboratory stewardship program now presents a valuable opportunity for laboratory professionals to exercise leadership within health systems and to drive change toward realizing aims in healthcare. The proposed framework for program implementation includes 5 key elements: 1) a clear vision and organizational alignment; 2) appropriate skills for program execution and management; 3) resources to support the program; 4) incentives to motivate participation; and, 5) a plan of action that articulates program objectives and metrics. This framework builds upon principles of change management, with emphasis on engagement with clinical and administrative stakeholders and the use of clinical data as the basis for change. These strategies enable laboratory professionals to cultivate organizational support for improving laboratory use and take a leading role in providing high-quality patient care.

Patient Population and Test Utilization for Thyroid Function in Local Clinics and Hospitals in Korea

“…This group of patients may represent the cause of physician difficulties in interpreting laboratory results, leading to follow-up and/or further tests to determine the clinical significance of TFTs. In clinical laboratories, knowledge of the prevalence of unusual results is important for risk management and to improve clinical laboratory service [ 6 ]. Information on the prevalence of specimens with specific test results can be used to evaluate the performance of a clinical test in the laboratory [ 18 , 19 ].…”

“…Thyroid function tests include the measurable thyroid stimulating hormone (TSH), total thyroxine (total T4), free thyroxine (Free T4), total triiodothyronine (total T3), free triiodothyronine (free T3), reverse T3, thyroglobulin, thyroxine-binding globulin, and various types of antibody tests to define characteristics of thyroid disorders [ 1 , 3 ]. Among these TFTs, several clinical practice guidelines on thyroid diseases are available, with TSH recommended as the initial screening test for thyroid function and the additional use of free T4 and/or total T3 (in Korea and United States) [ 4 , 5 , 6 , 7 ] or free T3 tests (European countries) for further assessment [ 1 , 8 , 9 ]. In Korea, both serum TSH and free T4 tests are recommended by the Korean Thyroid Association at the time of the initial evaluation when hyperthyroidism is strongly suspected, and total T3 measurement is helpful for the diagnosis of T3 toxicosis [ 4 ].…”

“…Confusing TFT results can be caused by characteristics of physiological changes for each hormone, samples of patients with and without thyroid illness, and by interference caused by characteristics of analytical methods [ 1 , 2 ]. It is important to understand the characteristics of a patient population, including the prevalence of diseases, to understand and evaluate the clinical performance of laboratory tests and to improve the quality of clinical testing [ 1 , 6 ].…”

Current state of laboratory test utilization practices in the clinical laboratory

“…14 , 15 Several institutions have cited the importance of multiple perspectives, especially from clinical experts, when establishing successful utilization/stewardship initiatives. 2 , 3 , 20 , 21 , 22 Strong support from institutional leadership has also been documented as an important factor in the success of utilization programs. 2 , 22 , 23 While a part of the multidisciplinary team recommended by guidelines, IT support can be especially critical in three main ways: 1) identification of tests that may be over- or under-utilized depends on being able to access data regarding test ordering patterns, 2) evaluation of utilization efforts depends on reviewing data both pre- and post-intervention, and 3) many utilization/stewardship interventions rely on IT support for implementation (clinical decision support, ordering restrictions, etc.).…”

Laboratory Supply Shortages

“…Central to any stewardship program’s success is engagement and partnership with clinical and administrative colleagues who support implementation of program initiatives. 5 Obstacles to such collaboration include conflicting priorities, matrixed management structures without clear lines of authority or accountability, entrenched beliefs, and leaders unwilling to take on the heavy (and often unpleasant) lift of implementing significant culture change. However, necessity is the mother of invention, and crises spur innovation and collaboration; laboratorians who have previously had difficulty gaining traction for stewardship programs may suddenly find many eager partners where few existed previously.…”