Your Lab Wisely role

Did you know? In Version 8 of the IQMH Medical Laboratory Accreditation Requirements, a requirement (II.D.8) for utilization management has been introduced for the first time.

 

II.D.8 – Laboratory management shall regularly evaluate the utilization of laboratory services and communicate with its users to drive value, improve patient outcomes and prevent inappropriate utilization.

What to Look For: 

Does laboratory management identify opportunities for utilization improvement through data analysis, feedback from users, and review of medical literature? Does laboratory management communicate these opportunities with users to promote the effective utilization of laboratory services? Does laboratory management monitor outcomes of initiatives and report results to users and facility administration (where appropriate)?

Assessors will expect to see evidence of:

  • review of laboratory test utilization and the creation of goals/initiatives to address opportunities;
  • collaboration, engagement and communication with users;
  • monitoring and reporting on goals/initiatives utilization.

 

When it comes to inappropriate utilization of laboratory tests, we might think of it as someone else’s problem. Here are some of the questions and comments we have received:

Question / Comment Response
Medical laboratory professionals (MLPs) “just” do what they are told in the most efficient, high-quality way possible, right? We would argue this is not the case as we are advocates and knowledge agents for our profession and patient care.
But, certainly, it is not within most MLP’s scope of practice to stop a physician from ordering a test? True, sort of! MLPs are experts in laboratory tests and procedures, and we have a voice and the ability to influence as knowledge agents in decision-making discussions with physicians and other health professionals.

We cannot stop someone from ordering a test in most cases, but we can inform health professionals of better choices and the latest research on Choosing Wisely Canada recommendations. We can also get involved in lab utilization projects and influential committees.

Choosing Wisely Canada recommendations do not apply to MLPs because they are for doctors. That is not true. Many health professions have contributed to the recommendations.

Approximately one-third of all their recommendations apply directly to our profession. As well, we have created MLP-specific recommendations that you will want to check out!

How does the lab contribute to inappropriate tests when we don’t order the tests? There is no single item that causes all test utilization issues and thus, the lab is not at fault. However, we all contribute to working in a system, and the lab can contribute to better utilization practices. Here are examples of how a lab can negatively affect utilization7:

  • introducing new tests without the evidence that proves their efficacy and effectiveness;
  • not restricting low value tests from the laboratory repertoire;
  • providing long turnaround time for test results;
  • using request forms that include large numbers of tests and profiles;
  • failing to establish or promote regular quality reviews of test ordering processes.

Why does inappropriate utilization of tests, treatments and procedures occur, generally? Well, there are many reasons which have been studied8, including:

We are boldly suggesting that MLPs are uniquely placed to improve utilization of lab tests and procedures.

A recent report from the PLUGS National Committee for Laboratory Stewardship states that it is vital for MLPs to be involved in lab utilization. They can contribute by facilitating the right consultations or guiding clinician understanding of testing algorithms. In addition, MLPs can potentially be involved in detecting whether inappropriate utilization is occurring through process improvement projects and research.
Laboratory stewardship programs generally have four elements: (a) governance, (b) interventions, (c) data extraction and monitoring, and (d) review of data coupled with strategies and tactics for improvement.

 

We are not limited to these few suggestions. It’s time to think beyond our traditional roles and cement the notion that ensuring appropriate lab tests and procedures is our professional responsibility. The volunteers who helped create the Choosing Wisely Canada recommendations for medical laboratory professionals have pulled together a list of ways you can contribute.

 

Need more suggestions?