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Document: Value of Clinical Laboratory Services in Health Care
Classification: Position Paper
Date: July 2005
Status: Approved by the ASCLS House of Delegates, July 2005

Background

Clinical laboratorians provide information and services that contribute to maximizing the effective delivery of care in today's complex healthcare system by assuring that the correct test is performed on the right person, at the right time, producing accurate test results that enable providers to make the right diagnostic and therapeutic decisions using the right level of health care resources.

Laboratory information enables physicians and other healthcare professionals to make appropriate evidence-based diagnostic or therapeutic decisions for their patients. Clinical laboratory services are the most cost effective, least invasive source of the objective information used in clinical decision-making. Clinical laboratory services have a direct impact on many aspects of patient care including, but not limited to, length of stay, patient safety, resource utilization, and customer satisfaction.

While technology continues to improve the productivity of today's laboratories, new technologies, new diseases, and disease strains continue to drive the need for more tests and testing. Changes in the world, such as bio-terrorism and the speed with which diseases spread globally drive the need for rapid diagnosis.

Thus, the clinical laboratory professional is an indispensable partner in providing patient care, and making direct improvements in the lives of patients, in the maintenance of the public's health, and in the effectiveness of individual health care providers

Rationale

Impacting diagnosis, identifying abnormalities: Laboratory professionals produce accurate, sensitive and specific information using new age technologies to guide clinical decision making. It is the role of laboratory professionals to inform physicians about which tests have the highest effectiveness in given clinical conditions. Through this partnership, the overall cost of testing and patient care is controlled and the quality of care is improved.

Laboratory information has a profound impact on patient diagnosis. Tests, whether classified as screening or diagnostic, are essential elements of protocols used to diagnose and manage specific diseases and conditions. Algorithmic testing models, designed with clinicians, are used to guide the diagnostic process to obtain the right information at the right time for a given patient, shorten the time to diagnose, the length of stay and improve utilization of laboratory services.4 These models assist in rapid identification of disease, assessment of severity of disease, creation of a therapeutic plan, and management/monitoring of treatment outcomes. The more efficient the testing protocol, the shorter the length of inpatient stay or outpatient encounter, the faster the implementation of therapy, and the lower the overall cost of care.

Change in patient management: The ability of a physician or other patient care provider to consistently make timely and evidence-based decisions which result in a change in care management is directly related to the availability of accurate, reliable and timely laboratory testing and reporting of results. A few examples that illustrate the laboratory professional's ability to be the primary enabler of therapeutic efficacy are:

  • Monitor the effectiveness of parenteral nutritional treatment
  • Ensure proper dosing of medication
  • Monitor harmful effects of therapeutic drugs
  • Identify the causes of infection
  • Determine effective antibiotic therapy
  • Monitor the effectiveness of cancer therapy
  • Provide real-time decision support

Clinical laboratory services provide the information required by a physician to start, adjust and also to stop a course of treatment. This allows for the most appropriate, cost effective use of expensive drugs and other therapies, and allows the patient to be treated at the most appropriate level of care for the most appropriate period of time. Without laboratory information, these decisions would be compromised at best.

Patient Safety and Impacting Patient Outcome: Clinical laboratory services are a vital component of ensuring optimal outcomes for all patients accessing health care, whether for simple situations or for complicated, potentially life threatening situations; including end-of-life care. Laboratory professionals impact patient safety by providing pre-surgical or pre-procedural testing that determines the current ability of the patient to undergo those treatments. Patient outcomes are influenced by providing the needed information for clinicians to monitor the effectiveness of ongoing treatments and therapies. Patient outcomes can also be measured by how well chronic illnesses are managed. Diabetics rely on laboratory support to monitor the long-term effectiveness of their home monitoring systems. Laboratory professionals provide vital information to assist clinicians in making decisions that affect quality of life for their patients.

Position

  1. ASCLS believes that clinical laboratory services are a vital component for ensuring optimal patient outcomes.
  2. ASCLS believes that the appropriate utilization of laboratory services by clinicians will result in efficient and effective clinical decision-making. Clinical laboratory professionals contribute to efforts to maximize effective and efficient healthcare delivery by assuring that the correct test is performed on the right person at the right time, producing accurate test results with the best outcome in the most cost effective manner. Laboratory professionals should inform healthcare providers about which tests have the highest efficacy and efficiency in given clinical conditions.
  3. ASCLS believes that clinical laboratories contribute to patient centered care by providing information for evidence based decision making. Laboratory test results are one objective measurement by which abnormalities may be identified, specific diagnoses may be ruled in or out, and decisions to start, adjust, or discontinue a course of treatment may be reached.
  4. ASCLS believes that it is vital to continue efforts to assure that laboratory professionals meet the high standards necessary to protect the public's health.
  5. ASCLS believes that laboratory professionals contribute important elements towards meeting the patient safety goals of the" Quality of Health Care in America" project and supports IOM's recommendation to raise the standards for health care professionals.
  6. ASCLS supports the continued efforts to establish, in all states, licensure (or state personnel standards) of clinical laboratory professionals as a means of assuring that only appropriately educated and qualified persons perform laboratory tests. This will require that all practitioners demonstrate continued competence through recertification and documentation of clinical competence in the workplace.
  7. ASCLS believes that it is vital to develop relationships with other state and national healthcare organizations to assure that there is an adequate workforce to meet the increasing demands of clinical laboratory testing.

References

  1. Forsman Rodney S. Why is the laboratory an afterthought for managed care organizations? Clinical Chemistry. 42: (5): 813-816. 1996.
  2. Forsman Rodney S. The Value of the Laboratory Professional in the Continuum of Care. Clinical leadership and management review, 370-373. Nov/Dec 2002.
  3. ASCLS Scope of Practice Position Paper, 2001.
  4. http://www.mgh.harvard.edu/labmed/ser/interp.htm visited June 10, 2005