Volume 36 Number 4 | August 2022
Jean Bauer, MLS(ASCP)CM, ASCLS Region V Director
The Greek physician Hippocrates is credited with the saying, “First, do no harm.” While this is not actually a part of the Hippocratic Oath, it is a statement that everyone in medicine needs to keep in mind when working with patients. Doing no harm and focusing on patient safety starts with accurate and complete patient registration. If this doesn’t happen correctly, the patient’s safety is at risk throughout their stay/visit. Their diagnosis and treatment could be delayed, and they may be at risk for the wrong medication or treatment. Once registered, patient safety needs to be maintained as the patient moves through the various departments that may be involved in successful diagnosis and treatment. From a laboratory perspective, this includes preventing errors and continuously working to improve processes in all phases of laboratory testing.
In the clinic setting where I work, interdepartmental interactions are extremely important as our primary focus is patient safety. The laboratory personnel are often the ones that catch any discrepancies that get past the reception area and/or nursing. When this happens, the departments work together to understand and correct the issue. Other issues that have occurred have caused the organization to form a safety committee with representation by all departments. Clinic management came to the logical conclusion that the committee should be headed up by the laboratory manager. With his laboratory background, they are confident that his approach to issues, identifying processes, tracking progress, etc., will be managed in a timely, efficient, and effective manner.
“With the right tests ordered, it avoids delay in getting to the correct diagnosis.”
This committee initially identified several patient safety concerns that did involve the laboratory. These concerns included ensuring the correct patient information upon arrival, correct labeling of patient specimens collected in the exam rooms, timely delivery of specimens to the laboratory, and appropriate billing. Since these concerns affect multiple departments, they have representation from each area impacted on any given issue and are developing the process to be used to resolve them. In general, they will likely use a Plan/Do/Check/Act (PDCA) cycle—using the identified issue, a plan of action is developed (Plan), the plan is trialed for a period of time (Do), an assessment of the plan—is it working?—(Check), and a change of the plan, if necessary, or continuation if the issue is resolved with this new plan of action (Act).
A recent concern that has come to the forefront is cost of in-house testing versus delay of test results. While this has been evaluated a number of times, with the physicians determining what testing is needed at the time of the visit, it has come to the surface again. While costs are always a consideration, at what price to the patient does cost take a back seat? It will be interesting to see if the new CMO determines testing can wait for the reference lab to complete the orders, or if the other providers prevail in keeping our current test menu in place.
In the hospital setting, our doctors of clinical laboratory science (DCLS) have a significant role, rounding with and assisting the physician to ensure the right tests, at the right time, are being ordered. While we do not have many practicing DCLS professionals to this point, those facilities that are utilizing them have seen the benefit of their role. With the right tests ordered, it avoids delay in getting to the correct diagnosis. Additionally, the delay in testing due to ineffective transport of specimens to the laboratory, incorrect labeling, etc., also exist within the hospital, as they do in the clinic. They are often interdepartmental, and to ensure a resolution to improve patient safety requires input and action from all areas involved.
The ASCLS Patient Safety Committee has created a toolkit to assist laboratory professionals in conducting patient safety activities. It offers a step-by-step procedure to conduct process improvement assessment. Access the toolkit. In addition, there will be a benchmarking process that will allow a hospital or clinic to measure itself against its peers. How does your facility and processes stand up against peers, and when is the process optimal? I look forward to bringing these tools to my clinic to assist and support their efforts to keep their patients safe.
As a medical professional, whether physician, nurse, medical laboratory scientist/technician, etc., one takes on a mantle of responsibility to our patients. A major part of that responsibility is to do our job to ensure we provide the utmost care and safety to our patients. With a team effort, working with our interdepartmental colleagues, we will provide a safe and effective environment for patients that give them the best opportunity to improve and/or maintain their health.
Jean Bauer is the Laboratory Director for Open Cities Health Center in St. Paul, Minnesota.