Laboratory Effectiveness: Clinical Laboratory Utilization

Author: Kevin F. Foley, PhD, DABCC, MLS, SC
Reviewers: Dina N. Greene, PhD, DABCC and Laurie Bjerklie, MA, MLS(ASCP)CM
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Continuing Education Credits

P.A.C.E.® Contact Hours: 1 hour(s)

Florida Board of Clinical Laboratory Science CE Credit Hours

Florida Board of Clinical Laboratory Science CE - Supervision/Administration, Quality Control/Quality Assurance, and Safety: 1 hour(s)

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In this course we define laboratory utilization and look at ways that the entire laboratory team can contribute to the laboratories utilization goals. Possible solutions to common utilization challenges are explored. Structuring a laboratory utilization team is discussed along with ways that laboratory professions can help guide clinicians to prevent misuse of laboratory services.

Objectives

  • Define laboratory utilization or lab stewardship and its overall goals.
  • Discuss the scope of practice for the laboratory professional in a utilization management role.
  • List issues and potential solutions concerning major problem areas, including outside (referred) lab testing, obsolete tests or tests of limited value, overbundled tests, stat tests, frequency of testing, tests that should be restricted, and genetic testing.
  • Describe the structure of a laboratory utilization team.
  • Discuss ways in which the laboratory can help clinicians avoid underuse, overuse, and misuse of clinical laboratory services.

Course Outline

  • Laboratory Utilization Management
    • What is Laboratory Utilization Management?
    • The Problem
    • Evidence-Based Practice
    • True or False: A goal of laboratory utilization management (UM) is to ensure that laboratory testing is both cost-effective and appropriately used.
  • Laboratory Utilization Management Team
    • Value of a Utilization Management Team
    • Who Should Be on the Team?
    • Team Meetings
    • Team Projects to Improve Laboratory Effectiveness
    • Which is a good practice for a Laboratory Utilization Management (UM) team?
  • Laboratory Utilization Issues and Potential Solutions
    • Referred Laboratory Testing: Laboratory Formulary Concept
    • Formulary
    • Advantages of Instituting a Formulary
    • Obsolete Tests or Tests Not Recognized
    • Tests of Limited Value
    • Changing Ordering Habits
    • Example of Overutilization Test Ordering
    • Overbundled Tests
    • Examples of Overbundled Tests
    • Defining Stat Testing
    • Frequency of Outpatient Testing
    • Frequency of Inpatient Testing
    • Under-ordered or Misordered Tests
    • Electronic Medical Record as a Utilization Tool
    • Electronic Medical Record as a Utilization Tool, continued
    • Laboratory Report Cards for Clinicians
    • Which method would be most effective for reducing excessive ordering on the same inpatient?
    • True or False: A laboratory formulary is a way to ensure proper staffing throughout the day.
  • Genetic Testing
    • Genetic Testing
    • Genetic Testing, continued
    • Getting a Handle on Genetic Tests
    • Genetic Testing Issues and Policies
  • Summary
    • Summary
  • References
    • References

Additional Information

Level of Instruction: Intermediate
Intended Audience: This course targets laboratory professionals who act in an administrative capacity or would like to increase their knowledge regarding laboratory administrative issues. It is also appropriate for medical laboratory science students and pathology residents.
Author Information: Kevin F. Foley, PhD, DABCC, MLS, SC,  is the Northwest chemistry, toxicology, immunology, and POC director for Kaiser Permanente. He also teaches pharmacology, clinical chemistry, immunology, and medicinal chemistry at Oregon Health Sciences University. Dr. Foley earned his PhD in clinical pharmacology and toxicology at East Carolina School of Medicine in North Carolina. His research areas include cardiovascular risk and inflammation markers as well as the neuropharmacology of amphetamine-like compounds. He is a frequent contributor to several clinical laboratory publications and is active in the American Association of Clinical Chemistry.
The author has no conflict of interest to disclose.
Reviewer Information:
Dr. Dina Greene is a Clinical Associate Professor at the University of Washington. She obtained her Ph.D. in Biochemistry at Emory University and completed the Clinical Chemistry Fellowship Program at the University of Utah. Her career has included directorship positions at Kaiser Permanente (Northern California and Washington regions) and University of Washington Department of Laboratory Medicine and Pathology. She has published over 100 peer-reviewed articles and book chapters related to clinical chemistry and laboratory medicine and has a particular interest in how sex and gender influence healthcare.
Laurie Bjerklie, MA, MLS(ASCP)CM, is a Lead Education Developer. She earned a B.S. in Medical Laboratory Science from the University of North Dakota and an M.A. in Curriculum and Instruction from Saint Xavier University. She has over 15 years of experience in higher education and has held program director and faculty positions in both MLT and MLS programs.