The document summarizes strategies implemented at Cleveland Clinic to reduce unnecessary laboratory testing and associated costs. Key initiatives included (1) implementing "hard stops" in the electronic medical record to prevent duplicate testing orders on the same day, (2) restricting ordering of expensive genetic tests to qualified providers, and (3) utilizing genetic counselors to review testing requests and prevent unnecessary orders. These initiatives helped avoid over $1.9 million in unnecessary testing costs from 2011-2013 through prevention of over 24,000 unnecessary orders. Factors contributing to the success of the strategies included leadership support, multidisciplinary collaboration, and responsiveness of IT to support implementation.
The purpose of this call is to learn how the Department of Family Medicine at Queen’s University was able to:
•Raise awareness about medication safety issues ‐ specifically medication reconciliation in primary care.
•Highlight the need for better communication and connectivity between hospitals, pharmacies, and primary care. (And how we can help each other.)
•Suggest that primary care take on a leadership role in medication safety ‐ we can (and should!) "own" the list.
•Stress the importance of medication reconciliation as a continuous, interdisciplinary, and collaborative activity.
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
The purpose of this call is to learn how the Department of Family Medicine at Queen’s University was able to:
•Raise awareness about medication safety issues ‐ specifically medication reconciliation in primary care.
•Highlight the need for better communication and connectivity between hospitals, pharmacies, and primary care. (And how we can help each other.)
•Suggest that primary care take on a leadership role in medication safety ‐ we can (and should!) "own" the list.
•Stress the importance of medication reconciliation as a continuous, interdisciplinary, and collaborative activity.
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Racing for results: lessons learnt in improving the efficiency of HIV VL and ...SystemOne
In pursuit of the 90–90–90 goals, emphasis has been placed on accelerating centralized laboratory HIV viral load testing of a population that is largely rural and decentralized. Successful
outcome requires effective specimen transport, laboratory testing, and results delivery. This paper focuses on the methods currently employed for results delivery. New innovations in this area are
yielding mixed results; we analyze different approaches and estimate the impact of each on achieving the third ‘90.’
The Business of Genomic Testing by James CrawfordKnome_Inc
View this webinar at: http://www.knome.com/webinar-business-of-genomic-testing. This presentation discusses the findings of a College of American Pathologists survey of “early adopters” of NGS recently published in "Genetics in Medicine". The study objective was to identify the reasons for health systems to bring next-generation sequencing into their clinical laboratories and to understand the process by which such decisions were made. A standardized open-ended interview was conducted with the laboratory medical directors and/or department of pathology chairs of 13 different academic institutions in 10 different states.
Tricks of the Trade: Patient Recruitment & Retention for Different Study TypesImperial CRS
In efforts to raise the bar for medical advancement, clinical trials are growing increasingly complex. This complexity, more often than not, leads to costly delays in enrollment. In this ebook, we'll take a look at 4 case studies for different study types, and examine the unique factors to consider during planning.
A Dartmouth Microsystem Assessment was conducted to examine a hospital unit\\’s functionality and to highlight opportunities for improvement. To enhance the gathering of data, a statistical tool was created to measure a wider sample population. The CNL student implemented a more reliable and valid data gathering system. The nurse educator asked to use the graduate student’s tool on the unit and throughout the hospital.
Racing for results: lessons learnt in improving the efficiency of HIV VL and ...SystemOne
In pursuit of the 90–90–90 goals, emphasis has been placed on accelerating centralized laboratory HIV viral load testing of a population that is largely rural and decentralized. Successful
outcome requires effective specimen transport, laboratory testing, and results delivery. This paper focuses on the methods currently employed for results delivery. New innovations in this area are
yielding mixed results; we analyze different approaches and estimate the impact of each on achieving the third ‘90.’
The Business of Genomic Testing by James CrawfordKnome_Inc
View this webinar at: http://www.knome.com/webinar-business-of-genomic-testing. This presentation discusses the findings of a College of American Pathologists survey of “early adopters” of NGS recently published in "Genetics in Medicine". The study objective was to identify the reasons for health systems to bring next-generation sequencing into their clinical laboratories and to understand the process by which such decisions were made. A standardized open-ended interview was conducted with the laboratory medical directors and/or department of pathology chairs of 13 different academic institutions in 10 different states.
Tricks of the Trade: Patient Recruitment & Retention for Different Study TypesImperial CRS
In efforts to raise the bar for medical advancement, clinical trials are growing increasingly complex. This complexity, more often than not, leads to costly delays in enrollment. In this ebook, we'll take a look at 4 case studies for different study types, and examine the unique factors to consider during planning.
A Dartmouth Microsystem Assessment was conducted to examine a hospital unit\\’s functionality and to highlight opportunities for improvement. To enhance the gathering of data, a statistical tool was created to measure a wider sample population. The CNL student implemented a more reliable and valid data gathering system. The nurse educator asked to use the graduate student’s tool on the unit and throughout the hospital.
Звіт за 2016 рік відділу інвестицій у транспортний комплекс Департаменту “Агентство з питань інвестицій та розвитку” Одеської обласної державної адміністрації
Patients Recruitment Forecast in Clinical TrialsCognizant
Inaccurate patient recruitment forecasts for clinical trials cost pharmaceuticals and medical device manufacturers a huge amount of resources each year. We offer descriptions and examples of applying stochastic and non-stochastic approaches to increase accuracy in this crucial stage of drug testing.
How does your facility incorporate EBP in a clinical setting to prom.docxfideladallimore
How does your facility incorporate EBP in a clinical setting to promote patient outcomes? Do you have recommendations on how your facility can improve its use of EBP?
My facility incorporates evidence-based practice in the clinical setting in a resourceful manner in order to promote patient outcomes. The institution integrates clinical expertise, the best research evidence and patient values in the decision making process to foster the implementation of evidence based practice. In this endeavor, the facility also encourages patients to bring their personal preferences, unique concerns, values and expectations in order to ensure that the clinicians have a heighted understanding of their pertinent medical issues and provide patient-centered care that meets the distinct needs of the patients.
According to
Polit & Beck (2011),
through the practice of EBP, the healthcare facility can be in a better position to ascertain the effects of therapy, the prognosis of diseases, the utility of diagnostic tests as well as the etiology of disorders. It is worth mentioning that my facility follows various steps in implementing the EBP practices. These steps include assessing the patient, asking clinical questions derived from the patient’s case, acquiring the evidence through searching appropriate resources and then appraising the evidence for its applicability and validity. The other steps usually include integrating the evidence with patient preferences, clinical expertise and applying it to practice. The institution also encourages all practitioners to evaluate their performance with the patient as a yardstick for determining the effectiveness of the EBP process.
Although the facility has registered notable success in its EBP initiatives, various recommendations can help it to improve on these processes. One of such proposals is to aim at creating and sustaining strong nurse-client relationships
(Majid, Foo, & Luyt, 2011)
. This can enable the practitioners to have a better understanding of the patient’s unique values and preferences, all of which are fundamental components of EBP practice. The leaders of the facility should also serve as positive role models through advocating, embracing and communicating the benefits of EBP to other employees in the organization. Ultimately, this will help to create a culture that supports the adoption and implementation of evidence-based practice across the entire healthcare establishment
(Polit & Beck, 2011)
.
References
Majid, S., Foo, S., & Luyt, B. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers.
Journal of the Medical Library Association, 99
(3), 229–236. Retrieved June 10, 2015, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133901/
Polit, D., & Beck, C. (2011).
Nursing Research: Generating and Assessing Evidence for Nursing Practice
(9 ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Discussion Question 2
Ho.
College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
How evidence affects clinical practice in egyptWafaa Benjamin
Evidence based medicine is the gold standard for clinical care.
It implies the integration of best research evidence with clinical expertise and patient values.
There is still a wide gap between availability of evidence and its incorporation into routine practice in our country.
Barriers to implementation could be personal, social, institutional, financial and legal barriers.
True practice of evidence based care can only occur where evidence based decisions coincide with patients’ beliefs and clinicians’ preferences.
Continuing medical education programs should be set with integrating evidence based medicine teaching and learning within clinical training.
The importance of presence of local national guidelines which need to take into account variation in expertise, resources and patient preferences across our geographical and cultural contexts .
Customisation of a guideline to meet the local needs of a target patient population is critical to successful implementation.
Why Devolution Is Clinical Trials' Best Chance of Success.pdfSollers College
Imagine a setting where groundbreaking medical research has the potential to transform healthcare delivery and improve people's health. Soller's clinical research management certificate and clinical trial management courses, along with clinical trial management training, serve the dual purpose of clinical research to learn and to heal.
With almost half of oncology studies failing due to a lack of patient retention, there is a critical need to develop more efficient and patient focused strategies. Jessica Thilaganathan at CRF Health sits down with International Clinical Trials to explain why electronic clinical outcome solutions could be the answer. (Published with permission of International Clinical Trials).
SDTM Training for personnel with Junior and Intermediate level Clinical Trial Experience. Covers summary of most domains. Salient features include order of domain creation, importance of making programming Data/Metadata Driven, Nature of Clinical Raw Data, Summary of the Clinical Trial process with regards to the data flow to arrive at the Study data to be submitted to regulatory authorities like FDA, Importance of deriving ADAM from SDTM and not directly from raw data, Information has been put together from variety of sources including my own programming work.
A Pharmaceutical Industry's Role in Clinical Trial Improvement.pdfSollers College
The drive to quickly develop a vaccine in record time should concentrate attention on common bottlenecks in the clinical trial process, as well as steps that the life sciences industry could take to reduce those bottlenecks and speed up the process for other drug candidates.
Clinical trials are necessary for medical research. Producing new medicines to the market depends on the strength of research organizations and drug companies to test and verify their work vigorously through their Clinical Trials, but finding people willing to participate is notoriously tricky.
Best Practices for a Data-driven Approach to Test UtilizationViewics
Would you like to learn how data-driven interventions can improve laboratory test utilization in your organization? Would you like to hear about the impact that leading hospitals/health systems and managed care organizations have made through these interventions?
If so, you might be interested in this presentation by utilization management expert Dr. Michael Astion, Medical Director at the Department of Laboratories at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington.
In this presentation, Dr. Astion discusses the current state of the misuse of laboratory testing in the United States and some of the interventions that are being implemented to improve it. He covers a number of common areas of unnecessary testing — from pure abuse to tests that could be useful but are ordered inappropriately.
You'll learn about:
• Two areas of laboratory testing where misordering of tests occur frequently
• Three interventions to improve the value of testing for patients
• The role of genetic counselors and other laboratory professionals in improving lab test ordering
• The national endeavor known as PLUGS, the Pediatric Laboratory Utilization Guidance Service
An introduction for those who may be interested in a career in clinical research, but need to understand the industry and their potential for a role in it.
Provides an overview of the later stages of drug development, explaining the phases of drug studies and explores in brief the key roles for those participating.
1. Strategies for
Appropriate Test Utilization
The Right Test for the Right Patient at the Right Time
Gary W. Procop, MD
WHITE PAPER
Laboratories
2. Gary W. Procop, MD
Medical Director, Enterprise Test Utilization & Pathology Consultative Services
Director, Molecular Microbiology, Parasitology and Mycology Laboratories
Professor of Pathology, Cleveland Clinic Lerner College of Medicine
2
The current healthcare climate is providing a great opportunity for pathologists and other laboratorians to take a
leadership role in decreasing unnecessary laboratory testing. Decreasing unnecessary testing results in decreased
phlebotomy and potentially iatrogenic anemia, increased patient satisfaction and reduced overall healthcare costs.
Presented here are successful strategies we developed and/or implemented to reduce inappropriate laboratory testing.
Unnecessary testing presents patient satisfaction and safety issues. The more tests performed, the greater the
potential for error (i.e., there is a false-positive rate associated with any test that has a specificity less than 100%).
From a patient satisfaction standpoint, it stands to reason that fewer phlebotomies would be associated with
greater satisfaction. From a patient safety standpoint, excessive phlebotomies may cause iatrogenic anemia, which
is associated with poor wound healing and increased infection rates. Finally, overutilization of laboratory testing
also creates unnecessary financial burdens for hospitals, patients and third-party payers in this ever-tightening era
of healthcare reform.
Addressing this issue at Cleveland Clinic, a physician-led group practice, was a substantial challenge, given the sheer
size of this tertiary care medical center, the volume of laboratory testing and the complexity of our patient population.
Our success was made possible through an open and transparent process, the support of leadership, the multi-
disciplinary participation of individuals from throughout the organization, our willingness to learn and change, and
the inclusion of high-level partners from Information Technology (IT).
The Test Utilization Committee at Cleveland Clinic is a multidisciplinary taskforce whose members are interested in
defining best practices associated with laboratory testing. This group truly adheres to Cleveland Clinic’s “Patients
First” principle. We would never compromise the quality of care for cost savings. If an expensive test is needed to
secure a diagnosis or guide therapy, then we support the use of such tests. However, we recognize there is substantial
waste in the system and that better utilization of these resources could also contribute to enhanced patient care by
bettering the system as a whole.
To enhance membership, diversity and expertise, we submitted invitations for participation to all Institute and
Department Chairs in our institution. It is a committee open to anyone interested in defining best practices, optimizing
test utilization and performing cost-effective medicine. We also partnered with high-level information technology
officers to aid in the electronic implementation of our endeavors, largely through the computerized physician order
entry system (CPOE). Both our Institute Chair and the Chief of Medical Operations, who in turn received support
from the Chief of Staff and CEO, approved the entire process.
3. 3
The Same Day Duplicate Test Reduction Initiative
The advent of CPOE systems allows the opportunity to interact with physicians at the point-of-test entry, so as to
assist with optimal ordering. Such methods can be used to guide physicians to the correct test, when the test selection
is complex and it can be used to notify the physicians of duplicate test orders. It is important to be sensitive to the
physician’s perspective, since excessive alerts are intrusive and distracting and, therefore, often ignored.
We discovered in early pilot studies that the use of best practice alerts (BPA) had mixed results. The BPA designed
was essentially a “pop-up” window that notified the physician that the test they were trying to order had already
been ordered that day. The clinician then had to choose whether or not to proceed with the duplicate order. Clinicians
with subspecialty expertise who were caring for a select patient population tended to do the right thing, which was
not order the duplicate test. In contrast, when we introduced this same type of intervention for all providers for a
commonly used laboratory test (e.g., C. difficile testing), then the alert was largely ignored. We have evidence that,
when offered the opportunity to electronically bypass, these busy providers often just “clicked through” the alert.
These studies provided evidence that a hard stop option should be explored to eliminate or drastically reduce this
unnecessary, duplicate testing.
The test utilization committee, in partnership with information technology representatives and institutional leadership,
embarked on what would come to commonly be known as the “Hard Stop” initiative. We first identified a dozen
tests that were deemed never to be needed more than once per day in medical practice. These were vetted by the
entire medical staff through notification on the institutional web page, which is the home page for all providers.
Although we were allowed to initiate a full electronic stop on these duplicate orders, we were also required to build
an alternative avenue for ordering, in the event the attending physician absolutely wanted the repeat test. We achieved
this through the engagement of our Client Services Department, which would record the name of the ordering
physician, their department, and the reason the duplicate test should be performed. Providers that demanded
duplicates were few, but the information gathered was educational and provocative.
There were no provider complaints associated with this initiative, so we progressively activated the hard stop clinical
decision support tool (CDST) for all tests the Test Utilization Committee deemed to be appropriate. In a conscious
manner to achieve substantial success and avoid conflict and complaints, any tests for which there was any contention
were not assigned to this list. This substantial implementation was associated with only minor unanticipated
complications, which were rapidly resolved. The presence of an informational technologist, who was intimately
engaged in this project and who could quickly remove tests from the hard stop list, was critical to responding
rapidly to clinical needs and helping to maintain end-user confidence in the process.
In the first full year of implementation of the Same Day Duplicate Test Reduction Initiative, the use of this CDST
resulted in the discontinuation of 7,243 unnecessary duplicate orders. The total laboratory cost avoidance (i.e.,
materials plus labor) was $115,590. Costs associated with providers either performing phlebotomies (i.e., nurse
draws) or responding to duplicate test results was not captured, but may be equally significant. We reviewed
patient safety data for the first year and there were no issues associated with this intervention. Since it began in
January 2011, this initiative has resulted in stopping 18,160 unnecessary duplicate tests for a cumulative cost
savings of $295,507 (Figure 1). This initiative is considered a success, since it is thought to have improved
patient care and satisfaction by decreasing unnecessary phlebotomies, and decreased costs.
Restricting the Ordering of Genetic Tests
Genetic testing has become extremely complex and very costly. We were concerned with test ordering patterns,
since there were very few individuals who could adequately interpret these tests, yet any intern or resident could
order the assay. Therefore, we undertook our second major initiative, which was limiting the individuals who could
order complex molecular genetic tests, some of which cost thousands of dollars. We reasoned that since chemo-
therapy is only given by an oncologist and certain antimicrobials are limited to infectious disease clinicians, then
some restrictions would be appropriate. We proposed that the best practice would be to limit the ordering of complex
molecular genetic tests to those individuals who were knowledgeable about the diseases for which the tests were
designed (i.e., they routinely cared for the select patient population that required testing).
4. 4
With the support of institutional leadership, we offered “deemed status” to physicians who met the above criteria.
These individuals could order molecular genetic tests on an outpatient basis, whereas inpatient testing required a
consultation with Medical Genetics. Individuals who were not a “deemed user” could obtain the genetic testing,
but only after consultation and approval of either Medical Genetics or another deemed user, or approval by the
laboratory. Laboratory approval included a thorough review by a genetics counselor, as well as approval by the
molecular genetic pathologist. Started in November 2011, this initiative has resulted in the avoidance of 273 tests
for a cumulative cost savings of $711,026, as of December 2013 (Figure 2). This was both an inpatient and
outpatient initiative. The outpatient component was associated with a loss of revenue, but this was considered
acceptable by the institution since it was considered a best practice.
Significant credit is given to institutional leaders who will take a monetary shortfall to implement a best practice.
Truly, a path less traveled.
Genetics Testing Review and Triage
The presence of genetics counselors within the laboratory has proven to be highly successful in other reference
laboratory settings. These highly knowledgeable individuals can participate in the sign-out of complex genetic test
results (e.g., chromosomal microarray analysis) and provide great pre-analytic value through test selection guidance
and triage. These individuals also contribute in the post-analytic setting by providing guidance with respect to the
need for genetic counseling and follow-up testing. There are some instances wherein the genetics counselor needs
the assistance of a pathologist trained in genetics and/or molecular genetic pathology (MGP). We have employed a
genetics counselor and a molecular genetic pathologist to review testing requests and interact with clinicians to
guide testing and help stop unnecessary testing.
The interventions and guidance from this team in 2013 resulted in the prevention of 151 unnecessary genetic
tests and a cost avoidance of $340,966. The impact of all interventions of this team, which began in September
2011, has resulted in the prevention of 261 unnecessary orders for a total cost avoidance of $820,887 (Figure 3).
Significantly, this approach does not just stop unnecessary testing, but also provides guidance to the appropriate
test — that’s World Class Care!
Regional Smart Alerts
An initiative was undertaken to expand the best practices and cost-savings initiatives achieved with the Hard Stops
to Cleveland Clinic’s regional hospitals. Through discussions with all involved, it was decided the Hard Stop CDST
would not be optimal for the regional hospitals for a variety of reasons, including provider mix and incomplete
provider use of order entry. Therefore it was decided that a duplicate order notification (i.e., a Smart Alert) would
be the best CDST to introduce.
Although providers are discouraged from proceeding with the duplicate test in the Smart Alert configuration and
are provided the results from the previous test, if available, they have the ability to continue and place the duplicate
order from their workstation. Although there is some benefit from this type of intervention, it is clearly not as
effective as the Hard Stop CDST.
Begun in February 2013, this initiative has prevented 5,625 duplicate tests for a total cost savings of $46,031.
However, the Smart Alert was activated 14,020 times, so the 5,625 times clinicians adhered to the alert represents
only a 40.1% success rate for this intervention. When compared with the 93% success rate of the Hard Stop CDST,
it suggests there are some missed cost-savings opportunities with this type of CDST (Figure 4).
Expensive Test Notification
This initiative was undertaken to make providers aware of the costs of tests that exceed $1,000. The notifications
were bracketed in $1,000 increments (i.e., >$1,000, >$2,000, etc.) (Figure 5). The project began in March 2013
and by December 2013, 66 expensive tests have been averted based on this notification (i.e., the provider began
to place the order, the alert fired, and the provider did not continue to place the order). These resulted in a cost
savings of $91,828.
7. 7
Cumulative Cost Saving through December 2013
1. Hard Stops 18,160 $295,507
2. Restricted Use 273 $711,026
3. Genetics Counselor/MGP 261 $820,887
4. Regional Smart Alert 5,625 $ 46,031
5. Expensive Test Notification 66 $ 91,828
TOTAL 24,385 $1,965,279
The Future
There are a number of new initiatives under way or planned. These include an “extended hard stop” project that
will extend the time period during which a duplicate test will not be allowed. For example, a constitutional molecular
genetic test never needs to be repeated in a patient’s lifetime. Additionally, it is clear that there is no value to a
repeat C. difficile PCR testing within seven days of having received a positive result and the value following a
negative result within this time frame would be minimal at best. Finally, a CDST is being deployed to stop ova and
parasite and stool culture order requests on patients hospitalized more than three days. These and other projects
will occupy the time of Cleveland Clinic’s Test Utilization Committee in the near future, as we continually strive
to improve patient care and prepare for the challenges of health care reform.
Conclusion
The Test Utilization Committee has raised the bar in asking for a quality assessment, “is this test really needed?”
Multidisciplinary collaborations, institutional support, good project management and reporting, and great informa-
tional technology support led to results that no one group could have achieved alone. Most importantly, we believe
we have improved the patient experience, decreased unnecessary phlebotomy for the commonly used tests, improved
the use of molecular genetic tests and decreased healthcare costs.
Importantly, our initiatives never interrupted patient care. While we wanted to ensure there was considerable thought
before a test was ordered, we have always provided an avenue for ordering if the physician really believed he or
she needed a test. The entire process has been an enjoyable lesson in team building and enhancing practice within
the system.
Keys to Our Success
• A multidisciplinary group of individuals representing many areas of the organization
• An open, transparent and collaborative process.
• Team members focused on optimal patient care, improving the patient experience, decreasing phlebotomy and
reducing costs
• Participants are more interested in improving patient care than reducing costs
• Collaborative meetings with mutual respect, acceptance, and healthy and collegial debate and innovation.
• Rational, evidence-based initiatives
• Good project management with regular results reporting with shared success.
• Leadership support
• Top-down support with bottom-up team building
• Inclusion of high-level partners from Information Technology
• The ability of IT to rapidly respond to change requests
• “Pre-selling” initiatives with the opportunity for feedback
• Anyone affected by a decision should be involved in the decision
• A willingness to learn and change
• Recognizing you do not have to win every battle to win the war
Pathologists and laboratorians are in a unique position, as individuals with oversight of many of these tests,
to take a leadership role in test utilization and function at the systems level in their institution.
Build or participate in a Test Utilization Committee today!