Value of Medical Laboratory Science Personnel and Clinical Laboratory Services in Healthcare

Introduction/Background

Medical laboratory professionals provide clinical information and services that contribute to the effective delivery of care in today's complex healthcare system. They are indispensable partners in providing patient-centered care and in improving health outcomes and overall public health.
 
Clinical laboratory services are one of the most cost effective, least invasive sources of 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, inpatient length of stay, patient safety, resource utilization, innovation in care, customer satisfaction and ultimately patient outcome. 1
 
Emerging and re-emerging diseases, pandemics, and bioterrorism agents with global impact showcase the crucial importance of identifying, tracking, and monitoring public health threats. Public health response and the need for ongoing surveillance highlights one of many critical needs for clinical laboratory services and qualified laboratory professionals.
 

Rationale

There are five common domains in which clinical laboratory services provide value within the healthcare system. 2-3 While the most commonly known is the provision of laboratory test results for clinicians, the other domains are of no less importance or value in improving the overall quality of healthcare in the United States.
 
Clinical Decision Support – Providing Test Results: 
Medical laboratory professionals produce objective clinical data using state of the art technologies to guide clinical decision making. This information has a significant impact on patient diagnosis. Tests, whether classified as screening or diagnostic, are essential elements of protocols used to prevent, diagnose, and manage specific diseases and conditions. Algorithmic testing models, designed with other healthcare team member input, are used to guide the diagnostic process to obtain the right information at the right time for a given patient. Additionally, clinical laboratory testing advancements allow for faster provision of results including options that are available at the patient bedside (inpatient settings) or within ambulatory locations. These patient-centered models assist in rapid identification of disease, assessment of severity of disease, creation of a therapeutic plan, and management/monitoring of treatment outcomes. 
 
Clinical Decision Support – Consultation and Collaboration: 
Medical laboratory professionals consult and collaborate with other healthcare professionals to ensure informed decision-making in patient care.1 Medical laboratory professionals at all levels of the practice, including the DCLS (Doctor of Clinical Laboratory Science) decrease medical errors and improve patient outcomes through service on diagnosis (diagnostic) management teams, quality improvement committees, and by participating in direct patient care activities related to clinical laboratory testing. Through these partnerships, medical laboratory professionals:
  • explain the advantages and limitations of specific tests, to assure that the right test is selected at the right time
  • provide guidance in the correct interpretation of test results
  • develop clinical laboratory evidence-based practice guidelines
  • utilize data to improve therapeutic practices through individualized precision medicine
  • collaborate with other healthcare professionals regarding patient treatment options
  • collaborate with specialty teams in bridging the gap between research and clinical application 
  • provide clinical data and support for risk management and patient safety
  • support the professional development process of other healthcare professionals by assisting with education and guidance relating to laboratory medicine  
Patient Safety and Health Outcomes:
Clinical laboratory services are one of the leading diagnostic services in healthcare.  Medical laboratory professionals are stewards of patient safety and are key healthcare team members in promoting a culture of patient safety and quality defined by the National Academy of Medicine (NAM) (formerly the Institute of Medicine) as “safe, effective, patient-centered, timely, efficient, and equitable” practice.4
 
Primary emphasis is placed on providing clinical laboratory services that improve the diagnostic process in medicine and health outcomes for patients served.  This is achieved by preventing:
  • delayed diagnosis through the provision of timely services
  • wrong diagnosis through clinical laboratory testing accuracy and the generation of laboratory data that supports the diagnostic process
  • missed diagnosis through appropriate clinical laboratory consultation support
Patient safety competencies are practiced in the provision of all clinical laboratory services.4 Medical laboratory professionals:
  • provide patient-centered care, recognizing the patient is the focus of the practice
  • employ evidence-based laboratory practice to facilitate and support change
  • apply quality improvement principles to processes to reduce opportunities for error and improve service delivery
  • use informatics as an essential component of the practice to enhance communication and provide safe healthcare delivery 
  • participate on interprofessional healthcare teams to provide laboratory medicine expertise in developing innovative and improved healthcare services.
Financial Value: 
Clinical laboratory services provide needed information to assure correct clinical decisions that influence patient outcome and healthcare cost. Improved patient outcomes will ultimately lead to decreased medical treatment costs, decreased inpatient length of stay as well as reduced inpatient readmissions. Decreased time to establishing a correct diagnosis and implementation of the most appropriate care for a patient will lead to decreased costs of care. Effective and efficient clinical laboratory services maximize low cost, high quality, timely delivery for operational efficiencies of the parent organization that contribute to:
  • preventing disease
  • detecting disease early 
  • establishing an accurate diagnosis
  • selecting the right treatment 
  • avoiding delays in treatment
  • improving care pathways
  • facilitating recovery
  • reducing disability
  • preventing relapse or retarding disease progression
  • reducing the need for long term care
Public Health & Policy - Research and Development Support:
Clinical laboratory services provide clinical data to support public health decision making and healthcare policy development. Additionally, clinical laboratory services have an impact on the evolution of analytical technology, molecular epidemiology, and bioinformatics. Clinical laboratory data provides core clinical information analytics to improve:
  • public health and regulatory policy
  • public health surveillance programs (e.g. newborn screening, lead toxicity screening, infectious disease tracing, foodborne illness tracing, bioterrorism threats, antibiotic resistance)
  • population health policy and global health strategies
  • health disparities through provision of screening services in underserved communities (colorectal cancer, prostate cancer, infectious disease)

ASCLS Position Statements:

  1. ASCLS believes that medical laboratory professionals provide clinical information and services that contribute to the safe and effective delivery of care.
  2. ASCLS believes that clinical laboratory services contribute to patient-centered care by providing information to allow diagnostic and therapeutic decision making by clinicians, other healthcare professionals, and patients. 
  3. ASCLS believes that medical laboratory professionals, at all levels of practice, are essential to communicating evidence-based clinical information that drives test utilization with the highest efficacy and efficiency in given clinical conditions.
  4. ASCLS believes that medical laboratory professionals have the knowledge, expertise, and responsibility to serve on multi-disciplinary quality improvement and patient safety healthcare teams.
  5. ASCLS believes that medical laboratory professionals provide essential contributions that support healthcare systems in meeting national patient safety goals, improving health outcomes and raising the safety standards for healthcare professionals.  
  6. ASCLS believes that medical laboratory professionals and the services they provide are critical in protecting the public's health. 

References

  1. Price CP, McGinley P, St John A. Where is the value of laboratory medicine and how do you unlock it? J Appl Lab Med. 2020 Sep;5(5):1050-60. https://doi.org/10.1093/jalm/jfaa116.
  2. Nadder T, Davis D, Sandhu PK, Uettwiller-Geiger D, Zibrat S. A review of published studies on the value of laboratory medicine. Clin Lab Sci [Internet]. 2018 Oct [cited 2020 Dec 14]. ascls.118.000729. Available from: http://clsjournal.ascls.org/content/early/2018/09/04/ascls.118.000729 Subscription required.
  3. Christenson RH, Grenache DG, Oellerich M. Special collection on the value of laboratory medicine. J Appl Lab Med. 2020 Sep;5(5):841-43. https://doi.org/10.1093/jalm/jfaa120.
  4. American Society for Clinical Laboratory Science, House of Delegates. ASCLS Position Paper: Patient Safety and Clinical Laboratory Science [internet]. 2015 Jul [cited 14 Dec 2020].  
  5. https://www.ascls.org/position-papers/185-patient-safety-clinical-laboratory-science  

Adopted by the ASCLS House of Delegates on January 17, 2021