In a medical office setting, the general office staff are often part of the de facto laboratory operation due to their responsibilities related to initially seeing, and communicating with patients. This includes the intake and update of patient information, test ordering, specimen acquisition, labeling and initial handling, as well as post-analytic patient contact and data access. The importance of well trained and competent office staff to perform these responsibilities cannot be overstated. The strategy for achieving this has been for the laboratory to initiate the outreach and provide the training. This approach has proven effective within the physician office setting.

However, we are now in an age of steadily increasing consolidation of healthcare delivery into comprehensive medical organizations, such as Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs), as well as expanding hospital systems and specialty clinics. It is estimated that fewer than one-third of physicians remain in private practice[i]. As a result, laboratories are increasingly operating as an integral part of the larger healthcare team. In order to ensure the highest level of patient care, laboratory oriented ancillary training and competency assessment must now go beyond the immediate office staff to include additional individuals and departments. This can include outreach to the Executive team, Risk Managers, Physicians, Nurses, Patient Care Technicians, and Patient Safety Officers.

It is also no longer sufficient for this outreach to be uni-directional, i.e. focused on the needs of the laboratory only. There must be a mutual understanding and respect for the responsibilities and priorities of each profession to provide quality patient care. We must also understand the daily experiences and stresses of those who are Nurses, O.R. and ER staff, and other allied healthcare professionals such as Respiratory and Physical Therapists.

This collaboration should explore the most effective strategies to ensure an integrated approach to patient care throughout the entire healthcare system. From the laboratory professionals’ point of view, we need to have others understand why pre and post-analytical processes are so important; that more errors occur in the pre-analytic phase than in the other phases. These include delays in patient processing, errors in specimen collection and labelling, lack of patient pre-test preparation and incomplete test orders. These can lead to delayed testing, the need to immediately redraw, even the need to have patients return to be redrawn; and that these delays can affect diagnoses and treatment. Post-analytic issues may include erroneous digital data entry and retrieval, mis-handling of follow up calls from patients regarding their test results and contacts from reference laboratories.

Once this attitudinal framework is in place, the next step is to set up committees to discuss specific points of interaction between the laboratory and each profession or department, identify areas of mutual concern; previous points of negative interaction; and how these impact patient care. Once the issues are clarified, solutions can be offered in a setting of mutual understanding, and strategies developed to implement these.

Besides these meetings and agreements, mechanisms for continuing education and competency assessments should be incorporated to ensure that quality standards are maintained. One approach is through the use of inter-professional on-line educational modules to strengthen the connection of quality and safety in laboratory medicine to clinical relevancy. This is how we can build institutional teams with enough respect, understanding, and competency to ensure that mutual best practices can be established.

[i] Survey: Fewer Physicians Are in Private Practice. 2011 AAPC.

Originally published in ADVANCE for Laboratory, Lab Quality Advisor Blog

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