The Institute of Medicine has determined that quality healthcare is safe, effective, efficient, timely, patient-centered and equitable. Each of these aims can be used to evaluate the quality of laboratory services, as well. Optimal patient safety, always the focus of our practice in the laboratory, requires that we constantly strive to improve the quality of the care we provide for patients.
Effective healthcare is defined as “providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit” – in other words, using evidence-based practice to ensure that laboratory services are used appropriately1. The goal of effective laboratory practice is to avoid overuse, underuse, and misuse of laboratory testing. Unnecessary or inappropriate laboratory testing may cause patient anxiety and discomfort, increased healthcare costs, and irrelevant or misleading results; on the other hand, failure to order an indicated laboratory test may result in a missed diagnosis.
In the pre-analytical phase of testing, effective practice ensures that the correct laboratory test is ordered, based on the patient’s signs and symptoms. In the analytical phase, appropriate utilization can be enhanced through reflex testing, in which additional analysis proceeds automatically based on initial patient results. During the post-analytical phase, accurate interpretation of patient test results leads to appropriate treatment or to additional necessary testing.
Improving the effectiveness of laboratory services could begin with a comparison of test utilization with practice guidelines in areas where overuse is common, and changes in the ordering process or educational materials for care providers may reduce overuse. Follow-up testing reminders in the electronic health record could help to avoid underuse. Narrative reports may improve clinician understanding of patient results, reducing misuse. 2
If you read the last entry in this series, “Ensuring Safe Laboratory Services”, you may recognize similarities between “safe” and “effective” care; both of these aims rely on requesting the correct test and correctly interpreting the results. Many of the IOM aims have overlapping goals, which is a good reminder that nothing we do as laboratory professionals happens in a vacuum: we should be constantly interacting with other healthcare professionals in every patient’s care, and the information we provide is a critical piece of every patient’s healthcare picture.
Committee on Quality of Health Care in America. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academy Press; 2001.
Hauser, RG and Shirts, BH. Do We Now Know What Inappropriate Laboratory Utilization Is? Am J Clin Pathol 2014; 774-783.