Laboratory medicine is on the cusp of a great transformation as ever more complex tests and innovative diagnostic technologies keep rolling out. An editorial in Clinica Chimica Acta proposed a 10-point manifesto that looks to the future, encouraging laboratorians to form diagnostic healthcare teams rather than continue with silo-based approaches in their efforts to reduce errors and improve care.
“The development of a new generation of laboratory professionals and leaders shall be encouraged, who will be able to integrate specific technical and administrative skills with a broader vision of healthcare and patients’ needs,” wrote the editorialists Mario Plebani, MD, Michael Laposata, MD, PhD, and Giuseppe Lippi, MD.
The first strategy revisits Laposata’s call in the Journal of Applied Laboratory Medicine to avoid tossing lab test results over to doctors who don’t always have the expertise to interpret those results. Failure to seek guidance from clinical laboratory professionals and not requesting the right test at the right time is leading to diagnostic errors, the authors contended. Laboratorians and physicians need to improve their interactions, forming diagnostic healthcare teams that include active participation from patients. In accordance with National Academies of Sciences, Engineering, and Medicine goals, lab professionals should receive training to participate in interdisciplinary teams “and more effective teamwork should be promoted,” they recommended.
Moving beyond traditional antimicrobial stewardship, which focuses mainly on tailored treatments, the authors recommend implementing diagnostic stewardship, which calls for modifications in ordering, performing, and reporting lab test results.
They also proposed structural changes in the healthcare framework. Addressing the similarities among laboratory professionals and radiologists, it may make sense to merge these two professions into one “diagnostic information specialist,” they suggested. Laboratorians should also re-examine how they use reference intervals and decision limits, “since unquestionable evidence has now been gardened that tests results may be classified as ‘normal’ with one analytical system, but can be classified as ‘abnormal’ with others,” according to the editorialists.
Plebani, Laposata, and Lippi also called for laboratory services to keep in step with the movement toward value-based payment for healthcare, focusing more on value of laboratory information in clinical pathways and patients outcomes.
Finally, the authors stressed the importance of teaching laboratory medicine in medical schools and in postgraduate courses. “Competent professionals are central to delivery of high-quality healthcare services, especially in an era of rapid and monumental advancements of both medical knowledge and technologies,” they wrote. Some lab professionals themselves could benefit from additional scientific, clinical, and technical training, given how complex some of their tasks have become.
Laboratorians aren’t just producers of data. Referencing the words of Steven H. Kroft, Plebani, Laposata, and Lippi noted that laboratorians are also creators of knowledge and managers of information, gatekeepers, stewards and guardians of quality, and patient advocates. Clinical laboratory professionals build processes and systems, and they consult and educate, as both team leaders and team members. “This well represents the job description of laboratory professionals which has become dramatically more complex in the last decades,” the authors concluded.