Patient-Centered Care and the Laboratory

Saddled with frequent budget cuts and less time with patients, hospitals are increasingly investing in a patient-centered care model. The laboratory’s role in patient-centered care is to provide technical and clinical advice that will aid physicians in appropriate lab test ordering and eliminate unnecessary testing.

“Ultimately, the goal is to provide the most appropriate, efficacious and cost-effective care for a patient’s medical condition, needs, values and circumstances,” explained Steven H. Kroft, MD, FASCP, president of ASCP and vice chair for clinical pathology and director of Hematopathology at the Medical College of Wisconsin at Milwaukee.

Patient care teams aim to improve outcomes and build partnerships with patients. “Patient-centered care relies on relationships between the patient and the healthcare team. These relationships are built through communication and empathy with the patient and family,” said Sherry Schmeler, MPA, MT, ASAP, SC, lab manager at La Rabida Children’s Hospital in Chicago. A pediatric specialty hospital, La Rabida treats patients with chronic diseases and traumatic injuries.

Defining the Laboratory’s Role
New approaches to healthcare require laboratories to demonstrate their value to hospitals and healthcare systems by ensuring proper stewardship of limited resources and facilitating the most effective care for patients, Kroft told ADVANCE. “This means engaging in and embracing the principles of patient-centered care,” he said.

The laboratory is responsible for making decisions regarding test procedures, instrument selection, and methodologies used, based on what is best for the patient population it serves. “We must consider how the tests and instruments selected impact the patient and the overall welfare of our patient population,” Schmeler said.

Today’s healthcare providers contend with limited resources and increased healthcare costs and regulations, Schmeler told ADVANCE. La Rabida aims to improve the hospital’s outcomes — which are tied to discharge and readmission rates — through patient satisfaction. “With limited resources, we need to prioritize the procedures we can afford and will have the greatest impact on our patients,” she said.

Laboratories have traditionally been in the data business, but they need to be in the knowledge business, Kroft explained. “Labs have a responsibility to make sure that patients get the right test with the right result at the right time and at the right cost,” he shared. “This involves engagement with the testing process through the entire lifecycle of a specimen, from the order to the application of the result in clinical decision-making.”

At La Rabida, the laboratory staff has built strong relationships with the rest of the healthcare team and regularly consults with other professionals on appropriate and cost effective laboratory test selections. “We save money and resources by performing only necessary tests on patients while giving physicians the information or confirmatory test results that are needed,” Schmeler related.

The laboratory at La Rabida does not employ a cookie cutter approach. “Each physician has tests they need to order for their specialties,” Schmeler said. “We have to consider the overall needs of the hospital as well as the individual. When we evaluate new methods, we take into account what is cost effective overall and what is best for the pediatric population.”

Reducing Costs and Improving Patient Care
Laboratory professionals need to be at the table when decisions are made that involve or affect the laboratory, Kroft said. These professionals are in a position to advocate for patient safety, best practices, and good stewardship of resources with stakeholders and decision makers.

The lab staff should work with clinicians to help build systems that enable the highest quality of laboratory services, especially in the pre-analytic and post-analytic phases, Kroft shared. “By positioning themselves as experts in the utilization and interpretation of laboratory results, the delivery of patient care will improve,” he said.

Kroft believes lab professionals should take a leadership role in developing and maintaining an infrastructure for utilization management in their health systems. He suggests reigning in the 20% to 30% over-utilization that currently exists, but also addressing under- and mis-utilization.

“The lab can spearhead efforts to develop evidence-based best practices around testing algorithms, decision support for ordering and interpretation, and a lab formulary,” observed Kroft. “These efforts will lower costs, while at the same time increasing quality and patient safety.”

To best serve patients, according to Kroft, labs need to ensure timely and accurate results and provide easy access to quality laboratory services. In addition, labs need to provide resources that allow patients and their physicians to understand laboratory results and how to best use them to individualize care.

The lab professionals at La Rabida communicate regularly with the physicians to discuss the impact of each diagnostic procedure on patient care and the hospital. Because the hospital has many different specialties, each child has its own care plan and healthcare team that contributes to her health. “We involve the patient in the process and let them become an active participant in the care plan,” Schmeler said.

Lab testing permeates every corner of medical practice and affects the majority of medical decisions. “Even though lab professionals are generally a couple of steps removed from direct patient contact, they nevertheless need to play a major role in patient-centered care,” Kroft shared.

Rebecca Mayer Knutsen is on staff at ADVANCE. Contact: [email protected]

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