Medical error is estimated to be the third most common cause of death in the US and may be responsible for approximately 10% of all deaths in 2013, according to recent research. And missed, delayed, or incorrect diagnoses can be part of the problem that puts patients at risk for adverse events. But while the laboratory’s potential to help minimize diagnostic errors is undeniable, it requires a transformation in the way laboratorians view the services they provide, according to experts who spoke during yesterday’s short course, “Towards Patient-Centered Laboratory Medicine – Using Lab Testing to Reduce Diagnostic Error and Improve Patient Outcomes.”
Michael Hallworth, MA, MSc, MCB, FRCPath and Danielle Freedman, MB, BS, FRCPath, EuSpLM encouraged laboratorians to shift their focus from only high-quality results to high-quality outcomes by emphasizing approaches to measure and improve the value of laboratory services. The value of the laboratory extends beyond providing quality results in an operationally efficient manner. Everyone can agree that even the highest quality result will not benefit anyone if it isn’t used appropriately or at all, they noted.
Hallworth, like many laboratorians who witness the practical value of laboratory testing on a daily basis, was frustrated at the lack of systematic evidence to support the value of laboratory medicine. “Past evidence of laboratory value has focused on efficiency and not on clinical effectiveness,” Hallworth explained. This is no longer adequate, he argued, especially given the contributions of laboratory testing to diagnostic error. We must shift our focus from “doing things right” to “doing the right things,” Hallworth said. He revealed deficiencies in the current delivery of laboratory medicine services that impact patient outcomes. One strategy he described was how to evaluate all tests—old and new—using evidence-based principles, much akin to phases of drug evaluation, to ensure that clinicians are utilizing clinically valuable tests.
The value of the laboratory must be most apparent at the clinician/laboratory interface, where tests are ordered and results are interpreted, according to Freedman. “Clinicians face many challenges in accurately, efficiently, and safely ordering and interpreting diagnostic tests,” she said. “We, in the laboratory, owe it to our patients and our clinicians to help support them in this process.”
Freedman offered clinical examples of how the laboratory adds value to the post-analytical testing phases to impact patient outcomes and reduce harm. She provided examples where reflective add-on testing motivated by abnormal results directly facilitated diagnosis. Crucial to this process is being able to directly engage end-users of laboratory services. Laboratorians should seek to influence physician behavior by providing minimum retesting intervals, incorporating clinician decision support tools, and vetting testing requests, argued Freedman. Furthermore, patients should be looped in to laboratory testing so that they feel empowered to participate in their own care. Designed for patient education, AACC’s Lab Tests Online has proven to be a useful resource for patients and healthcare providers alike.
The conversation on promoting value-based laboratory services continues today during this morning’s symposium “Diagnostic Errors and Clinical Laboratories.” Mark Graber, MD, a national leader in the field of patient safety, will approach medical error from the perspective of internal medicine. Laboratorians will be called to action by Michael Laposata, MD, PhD, who contends that laboratory directors must move beyond the logistics of laboratory operation and re-direct their efforts toward counseling clinicians on test selection and result interpretation. Mario Plebani, MD, FRCPath, FNACB, will close the session by summarizing the nature of laboratory-associated diagnostic errors encountered and by proposing quality indicators to reduce the risk of errors throughout the total testing process.