For the last 13 years I have been asking myself, what do physicians need from laboratories? In my work as a clinical chemist at a 326-bed community hospital, I liaise between our technologists and our clinicians for a laboratory that performs 1.5 million billable tests per year, and I support the laboratory’s entire portfolio of operations—hematology, coagulation, urinalysis, chemistry, microbiology, and point-of-care testing—not just clinical chemistry.
I realized very quickly in this role that most everything physicians want from laboratories is reasonable, including lab results that are reliable, fast, accurate, dependable, and trustworthy. Some but not all also are concerned about test cost. However, they need much more from laboratories than analytical performance. They see laboratories as data producers (a service), not as knowledge experts (a consultative resource). To be honest, a lot of us (laboratorians) see ourselves similarly; we like focusing on the analytics of diagnostic testing and are comfortable within the confines of our lab space.
But in my view, we clinical laboratory professionals have a crucial responsibility to educate physicians about our consultative capabilities and to exercise our know-how for the betterment of patient care.
What Labs Offer
From my perspective, most physicians are unaware that their laboratories could serve in at least seven valuable roles (Box, p. 5). Over time I have positioned our lab to be these things for our physicians and I hope my experience will inspire others in their journeys to becoming consultative resources, no matter the size of their labs or hospitals.
When I came to OhioHealth Mansfield Hospital, my position was focused mostly on the analytical aspect of lab medicine, but I had a special interest in the transition of care and how labs fit into the patient care continuum. I started becoming a visible consultative resource by building up my professional relationships. I also identified a possible laboratory champion—the vice president/chief medical officer who was in charge of developing our computerized physician order entry order sets enterprise. I presented myself to him via an e-mail like I was applying for a job, making him aware of my training and what I could do for the hospital. To my surprise, weeks later he knocked on my door and gave me the opportunity to assist with revising our Emergency Department (ED) order sets.
As part of this team effort, we revised order sets involving the 25 most common chief complaints among patients presenting in the ED. In the case of “nontraumatic chest pain,” after we improved the order set used to workup suspected myocardial infarction (MI) it was natural to revamp the order set for patients admitted with MI, who would be followed by internists and cardiologists. So, my work with ED orders opened the door for me to begin working with other physicians.
By this time, specialists had heard about my being a resource for lab testing utilization and interpretation, so the lab quickly gained a lot of visibility and had more and more interactions with clinicians. This was happening when the hospital and our physicians were working to deal with regulatory changes, new Centers for Medicare and Medicaid core measures, quality and patient safety concerns, as well as processes that were dissatisfying physicians.
With all these things in play, I realized my next opportunities were right in front of me. Before being asked, I developed and presented solutions based on the scientific method to our hospital leaders. In addition, I followed up with personal meetings, sometimes even catching colleagues in the hallways. One of my proposals—to identify and notify physicians of clinically significant changes in troponin values in patients being evaluated for suspected MI—got accepted as a pilot. This faster identification improved our care efficiency and outcomes and paved the way for other projects to be accepted.
At this point I started receiving invitations to participate in different committees, and clinicians and administrators were asking not only me but also the entire lab staff for opinions and recommendations. While these changes were afoot I rebalanced my time so that I would be in the hospital when physicians were rounding and early morning results being produced. So, my day now starts at about 6:15 a.m.
A Team Effort
While I have described my actions in moving our lab to a consultative role, the entire lab—from medical technologists to doctoral level staff—plays a part in this effort. All of us have the collective knowledge of laboratory medicine, and our consultations range from answering technical questions and providing individualized clinical interpretations to having informal conversations and giving real-time clinical decision support inputs.
While we haven’t abandoned our role as traditional troubleshooters, we have positioned ourselves as responsible and accountable partners in preventing diagnostic errors. In other institutions as in ours, once physicians discover this cache of expertise they will use it and even request it in their own efforts to order the right test with the right patient at the right time.
Eugenio H. Zabaleta, PhD, is a clinical chemist at OhioHealth Mansfield Hospital in Mansfield, Ohio.+Email: [email protected]