Anything that is wasteful or has to be repeated is considered inefficient. As healthcare costs continue to skyrocket, it is no surprise that the Institute of Medicine has made ‘efficiency’ one of the six Quality Aims1. Wastefulness in the laboratory can be in tangible form, such as reagents, supplies, and equipment, and in abstract form, such as personnel (and patient) time and energy.
Waste is evident in all steps of the total testing process, but is most prominent in the pre- and post-analytical areas2. Errors in specimen collection, such as a missed collection, wrong tube type drawn, unlabeled specimen submitted, and insufficient quantity of specimen, all lead to repeat collections and waste of supplies and time before analysis. Post-analytically, issues may arise in communication of test results, particularly critical values, when the laboratory professional is unable to reach the appropriate individual in a timely manner, and has to waste time repeating phone calls3. Many of these issues can be addressed with proper training, competency checks, devoted supervision, and prompt error recognition and resolution.
What many laboratory professionals don’t always realize is how much waste can occur at the intersection of clinical care and the laboratory. A sixth consecutive CBC ordered after the first five were normal is wasteful. A clinician ordering an inappropriate test for a given condition is wasteful. A delay in diagnosis or treatment because assistance with result interpretation was not readily available is wasteful. This is just a handful of examples. It is imperative that laboratory professionals communicate with the clinical team to identify areas where improvements to test selection and interpretation can be made, employ information technology to help identify waste and inefficiencies so solutions can be reached, and stay current on the latest best practices to ensure the right patient will have the right test performed at the right time.
1Committee on Quality of Health Care in America. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001.
2Stankovich, AK. The laboratory is a key partner in assuring patient safety. Clin Lab Med. 2004 Dec 24(4): 1023-1035.
3Howanitz, PJ. Errors in laboratory medicine: practical lessons to improve patient safety. Arch Pathol Lab Med. 2005 Oct 129(10): 1252-1261.