Virtual Issue: Lab Management and Administration

Although clinical pathology and laboratory medicine are diverse disciplines, one task is shared by virtually all of their more senior practitioners: management and administration. Pathologists and laboratory professionals have statutory authority over the laboratories they direct, and typically are involved in operational, financial, and quality concerns. In this virtual issue, we have selected 12 recent papers appearing in American Journal of Clinical Pathology or Lab Medicine that focus on laboratory management and administration topics.

Reducing unnecessary laboratory testing has been a goal of laboratory professionals for many years, and is the purpose of the ABIM and ASCP “Choosing Wisely” initiative. Three papers examine aspects of laboratory utilization: Salinas, et al., compared ordering patterns for transaminase enzymes, urea, and creatinine to assess regional variations and address discrepancies, with the goal to approach benchmarks established in the literature for use of these analytes in a primary care setting. They identified significant potential for savings through optimization of the ordering patterns. Rudolf, et al., describe their effort to reduce inpatient test orders through directed interventions that included interdepartmental collaborations, policy creation, clinical decision support, and continuous auditing and feedback. Their initiative reduced annualized daily order volume from 25,000 to 10,000 over the 33 month post-intervention review. Konger, et al., implemented an electronic laboratory utilization management system that resulted in an 11% decrease in test orders, with annual cost savings of over $150,000.

Three papers examine technical issues that arise from the enormous amount of data processed by a clinical laboratory. Grieme, et al., determined the frequency of “incidental” critical values, which are critical results for tests that have not been ordered but are part of an automated profile, to assess their potential clinical value. They conclude that incidental critical results appear to have low clinical utility. Naugler and Guo evaluated a new metric, the mean abnormal result rate, as it reflects the selectivity of laboratory test orders. Interestingly, they found that a single test has about a 14% chance of being abnormal, whereas if 9 or more tests are ordered, the expected frequency of abnormal results drops to 7%, consistent with the notion that selectivity in test ordering improves the efficiency of laboratory utilization. Schmidt, et al., measured the effects of improving test result comments to aid clinicians in their interpretation. Calls to the laboratory for clarification and interpretation were significantly reduced by the improved test result comments.

Medical errors and patient safety have been a frequent topic of discussion since the famous 1999 IOM report “To Err is Human.” Three papers in this virtual issue focus on reduction of errors in the laboratory. Heher, et al., used the principles of the Lean management system to improve the workflow in a histology laboratory, and achieved a nearly 80% reduction in specimen labeling errors. Kantartjis, et al., installed an electronic specimen collection module in an outpatient phlebotomy setting, and noted a decrease in the preanalytical errors and patient wait times, the latter translating into greatly improved patient satisfaction scores. Banks, et al., report the recommendations of the Initiative for Anatomic Pathology Laboratory Patient Safety (IAPLPS), which include 47 separate metrics that can be used to monitor specimen handling processes and reduce specimen misidentifications.

The remaining 3 papers address multidisciplinary issues involving the clinical laboratory. Cao, et al., describe their experience at University of Minnesota establishing a stand-alone laboratory to support an Ebola virus treatment facility at their institution. They identified risk assessment, instrument validation, and employee training as major components of their success. Kim, et al., review the importance of antimicrobial stewardship programs involving pharmacists, infectious disease specialists, and clinical microbiologists. They describe their establishment of such a program at the Milton S. Hershey Medical Center in Hershey, PA. Finally, Taylor, et al., discuss opportunities for laboratory professionals to play a greater role in the diagnostic process by their participation on clinical care teams, an initiative that has long been championed by Dr. Michael Laposata, who penned an editorial on this subject for the September, 2015 issue of Lab Medicine.

We sincerely hope you find this virtual issue, the first such collaboration between the two sister journals published by the ASCP, enlightening and informative.

Michael Wilson, MD
Editor, AJCP

Roger L. Bertholf, PhD
Editor, Lab Medicine