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How to Set Up a Clinical Laboratory Stewardship Program


Clinical Laboratory Stewardship

Introduction

Clinical laboratory tests play a crucial role in healthcare, influencing over 70% of medical decisions. Despite their importance, studies suggest that 20-30% of these tests may be unnecessary or improperly utilized. Over-reliance on lab tests can cause inefficiencies, drive up healthcare costs, and even harm patients by leading to incorrect diagnoses or delayed treatments. Recognizing this, many healthcare organizations are implementing Clinical Laboratory Stewardship (CLS) programs to make better use of testing resources.

 

This article discusses how to design and implement a CLS program, focusing on the key elements, people involved, and strategies that are essential for success.

 

Table of Contents

 

Laying the Groundwork for a Clinical Laboratory Stewardship Program

Before anything else, it’s important to understand why a CLS program is needed: to improve patient health and economic outcomes focused on how laboratory testing services are provided and received. If testing is excessive or poorly chosen, it can lead to significant waste in terms of both money and time, not to mention potential risks to patient safety. For example, ordering too many tests can result in false positives, which might prompt unnecessary follow-up procedures, while failing to order critical tests in a timely manner can delay diagnoses, potentially harming patient outcomes. A well-run CLS program tackles these challenges by streamlining test selection, cutting down on overuse, adhering to evidence-based protocols, and ultimately improving patient safety by reducing diagnostic errors.

 

Assembling the Leadership Team

For a CLS program to truly succeed, it’s important to bring together a team that spans several key departments within the healthcare system. This group will oversee strategic planning and decision-making, as well as ensuring the program remains viable in the long run. A well-rounded team would include:

 

·      Clinical laboratory directors who understand laboratory operations.

·      Clinical and anatomical pathologists who can provide expertise on appropriate test ordering and result interpretation.

·      Physicians and clinicians who represent the end-users of the laboratory tests.

·      Nurses to insights on care coordination and patient management.

·      Pharmacists who contribute their knowledge in therapeutic drug monitoring.

·      Hospital administration who ensure the program aligns with the organization's value-based care goals and provides financial backing.  

·      Informatics specialists to help with data extraction and electronic medical record (EMR) integration.

·      Quality personnel who focus on patient outcomes.

 

At the helm, a CLS champion - typically a lab director or pathologist – or someone with direct exposure to daily laboratory processes, understands the limitations of data extraction from the laboratory information management system, and routinely see the application of test results to make important clinical decisions will coordinate efforts across the departments and ensuring smooth implementation.

 

Evaluating Current Testing Practices

Before making any changes, it’s vital to get a clear picture of how lab tests are currently being used. This can be done by performing a thorough assessment of ordering patterns, test frequencies, and how usage differs across departments. A good laboratory information management system makes this process easier by providing tools for data extraction and analysis. Key areas to focus on include high-cost or high-volume tests, how current practices align with clinical guidelines, and whether test usage measures up against national or regional standards. This initial assessment provides the baseline information needed to guide the program’s direction and track its progress.

 

Setting Goals and Metrics

Once the current state of test utilization has been established, it’s time to set clear, achievable goals for the CLS program. These could range from reducing orders for certain costly or overused tests to improving turnaround times in the lab. For example, if one goal is to cut down on unnecessary testing, a hospital system might aim for a specific percentage reduction within a set timeframe. Another objective could be ensuring that clinicians are following evidence-based guidelines for particular conditions, such as cardiac testing upon presentation at the emergency room. To track progress, it’s helpful to establish key performance indicators (KPIs), which could include metrics like the number of tests ordered per patient, overall costs, and/or clinical outcomes. Regularly reviewing these KPIs ensures that the program stays on track.

 

Designing Targeted Interventions

With goals in place, the next step is to put strategies into action. A popular approach is to integrate clinical decision support (CDS) tools into the electronic medical record (EMR) system. These tools help clinicians order the right tests by providing evidence-based recommendations based on the patient’s symptoms and history. Another option is reflex testing, which triggers a follow-up test only if initial results meet specific criteria. For example, a positive strep test might automatically lead to a bacterial culture. Establishing a review committee can also help streamline the process by overseeing new test requests, modifying panels, and identifying areas where redundant testing could be eliminated. Education is another critical piece - ensuring clinicians understand how to use tests appropriately and the risks of over-testing. Additionally, introducing test restrictions can help ensure that only specialists or clinicians in certain situations order high-cost or complex tests.

 

Monitoring and Evaluation

For the program to succeed, it’s crucial to monitor its performance. This involves collecting real-time data on test usage, whether clinicians are adhering to guidelines, and patient outcomes. Regularly reviewing this data helps to identify trends and measure whether the interventions are achieving their intended results. It’s also important to watch for any unintended consequences, like the risk of under-testing. Continuous evaluation allows the leadership team to refine their strategies and adjust as necessary.

 

Sustaining the Program for the Long Term

Once the CLS program is up and running, the work doesn’t stop. It’s important to monitor how testing practices evolve over time and identify new areas for improvement. Regular audits can help you stay on top of emerging trends, while involving new stakeholders—such as patient safety officers—can ensure the program remains aligned with broader healthcare goals. Celebrating successes along the way, such as cost savings or improved patient outcomes, is also important to maintain momentum and secure ongoing support from the organization.

 

Conclusion

Setting up a clinical laboratory stewardship program is a powerful way to enhance the quality and efficiency of healthcare delivery. By optimizing how laboratory tests are used, institutions can not only improve patient outcomes but also cut down on unnecessary costs and build a stronger culture of evidence-based practice. With the right planning, involvement from key stakeholders, and regular monitoring, a CLS program can deliver lasting benefits for both patients and healthcare providers.

 

Schedule a free consultation with our clinical laboratory consultants to get started on your journey of starting a clinical laboratory stewardship program in your diagnostic laboratory.



 

Additional Resources

 

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