Classification: Position Paper

Status: Approved by the ASCLS House of Delegates, July 2015. Revisions adopted by the ASCLS House of Delegates, June 2023

Introduction

It is essential for medical laboratory professionals to fully integrate patient safety concepts and competencies into the practice of clinical laboratory science to assure that services provided are safe, effective, patient-centered, timely, efficient, and equitable.1

Background

Dramatic changes have taken place throughout the healthcare delivery system since several key resources have been published by the National Academy of Sciences, Engineering and Medicine (NAM) and the Institute for Healthcare Improvement (IHI). These publications include:

  • To Err is Human2 published in 2000
  • Crossing the Quality Chasm published in 2001
  • Health Professions Education: A Bridge to Quality 4 published in 2003
  • Improving Diagnosis in Health Care 5 published in 2015
  • Safer Together: A National Action Plan to Advance Patient Safety 9 published in 2020
  • Declaration to Advance Patient Safety 10 published in 2022

As a result of these publications, healthcare professionals and healthcare delivery systems have focused on reducing and preventing systematic and diagnostic errors that can result in harm to patients. In 2001, ASCLS published its first position paper in support of the importance of laboratory services incorporating the NAM six aims to improve healthcare.

Because of its vital role in patient care, medical laboratory professionals have identified the need to incorporate NAM aims as the framework for evaluating and improving its services, integrating the NAM aims and competencies into pre-certification curricula and entry-level competency requirements, and including patient safety concepts in certification exams, credential maintenance requirements, and continuing education offerings.

Rationale

The aim of clinical laboratory science and its services during all phases of the total testing process is to improve healthcare quality as defined by NAM. The six-quality measures to improve healthcare as they relate to medical laboratory services 6-7 include:

  • Safe laboratory services assure care that avoids harm to patients and enhances patient care outcomes through error prevention, continuous process improvement, and appropriate services for each individual.
  • Effective care uses scientific knowledge to limit overuse, underuse, and misuse of laboratory testing services.
  • Patient-centered laboratory care is responsive to, and respectful of, patient preferences, needs, and values, and must include either face-to-face or written communication for patients about medical laboratory tests and patient rights.
  • Timely laboratory services reduce wait times for patients and other providers of healthcare, so that the next step in care is not delayed.
  • Efficient laboratory services avoid waste, which includes time, supplies, equipment, energy, and ideas.
  • Equitable laboratory services are consistent in quality regardless of patient characteristics such as gender, ethnicity, geographic location, or socioeconomic status, and are tailored for individual circumstances.

Many healthcare professions have revised their curricula and practice to include the competencies identified by the NAM Health Professions Education Summit as vital to improving patient safety.4 Five competencies are designated as essential for all healthcare practitioners to master to improve healthcare quality and patient safety:

  • practice evidence-based medicine,
  • focus on quality improvement,
  • use information technology,
  • deliver patient-centered care, and
  • work in interprofessional teams.

These defined healthcare professional competencies can be incorporated into the daily practice of medical laboratory professionals by:

  • Utilizing evidence-based laboratory practice to provide effective healthcare;
  • Applying quality improvement principles to laboratory processes to reduce opportunities for errors that could harm patients and to improve patient outcomes;
  • Utilizing informatics as an essential component of their practice to manage and communicate clinical laboratory diagnostic information;
  • Recognizing that the patient is the focus of our practice;
  • Providing laboratory testing expertise to interprofessional healthcare teams as they develop and provide standards of care.

Medical laboratory professionals must adopt a ‘fair and just culture’ philosophy, recognizing that humans make errors, and understanding the science of safety and error prevention. Medical laboratory professionals promote the culture of safety as an organizing principle in certification and licensure of professionals at every practice level and in the accreditation of programs at all educational levels.8

  • Patient safety competencies must be an integral component of the accreditation requirements for all clinical laboratory science educational programs.
  • Educational curricula must address competencies necessary to improve patient safety and add value to service delivery to ensure care is safe, effective, patient-centered, timely, efficient, and equitable.
    • Curricula must be expanded beyond the basics of patient identification and analytical accuracy by enhancing students’ understanding of additional pre- and post-analytic sources of error, quality improvement strategies that measure impact of diagnostics on health outcomes, utilization of evidence-based practice methods and basic principles of integrated electronic health record systems and reporting.
    • Patient safety competencies must be foundational components of the certification and licensure requirements for all practice levels.
    • Patient safety competencies must be a component of the continuing education and credential maintenance of medical laboratory professionals

ASCLS Position Statements

  1. Medical laboratory professionals provide diagnostic services and leadership to improve patients’ lives and health outcomes.
  2. Medical laboratory professionals are stewards of patient safety and must promote a culture of safety as defined by the NAM and the IHI.
  3. Medical laboratory professionals are responsible for partnership and collaboration in patient safety initiatives.
  4. Medical laboratory professionals must incorporate each of the NAM defined healthcare professional competencies into daily practice.
  5. Medical laboratory professionals must promote the culture of safety as an organizing principle in certification and licensure of professionals at every practice level and in the accreditation of programs at all educational levels.

References

  1. American Society for Clinical Laboratory Science. Position Paper: Value of Medical Laboratory Science Personnel and Clinical Laboratory Services in Healthcare. July 2021.
  2. Institute of Medicine (IOM). 2000. To err is human: building a safety health system. Washington, DC: National Academy Press.
  3. Institute of Medicine (IOM). 2001. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press.
  4. Institute of Medicine (IOM). 2003. Health Professions Education: A Bridge to Quality. Washington DC: National Academy Press.
  5. National Academies of Sciences, Engineering, and Medicine. 2015. Improving Diagnosis in Health Care. Washington, DC: The National Academies Press.
  6. Otto CN. Patient Safety and the Medical Laboratory: An Introduction. Clin Lab Sci 2011; 24: 105-107.
  7. Otto CN. Patient Safety and the Medical Laboratory: Using the IOM Aims. Clin Lab Sci 2011; 24: 108-113.
  8. Morris S, Otto CN, Golemboski K. Improving Patient Safety and Healthcare Quality in the 21st Century-Competencies Required of Future Medical Laboratory Science Practitioners. Clin Lab Sci 2013; 26: 200-204.
  9. National Steering Committee for Patient Safety. Safer Together: A National Action Plan to Advance Patient Safety. Institute for Healthcare Improvement (IHI); 2020. Boston, Massachusetts: (Available at www.ihi.org/SafetyActionPlan)
  10. National Steering Committee for Patient Safety. Declaration to Advance Patient Safety. Institute for Healthcare Improvement IHI); May 2022. Boston, Massachusetts: (Available at www.ihi.org)