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Press Start: Lead an Empowered Life as a Clinical Laboratorian

What Do Doctors Want from the Laboratory- Part 2?

Published August 25, 2014 11:50 PM by Glen McDaniel


In the last blog we discussed a CDC survey addressing the difficulties many providers face in ordering and interpreting laboratory tests. The providers admit to having significant challenges in both ordering tests and interpreting laboratory test results. They routinely seek help from various sources, with the laboratory being at the bottom of the list. Further they agree laboratory consultation would be a logical adjunct in helping navigate the information maze, but they don’t go that route for several reasons; none related to the ability or expertise of the laboratory.

 

In the area of test interpretation, physicians find the following most useful: followup with patients face to face, review of patients’ histories and consulting e-references. Asked why labs fall way down on their list of consults, the respondents indicate among other inconveniences  of calling the lab is the long time it takes to get someone on the phone who is able or willing to answer questions.

 

One physician gave this example of I what he terms inefficiency, ” I called the lab to ask about the swab needed for a particular culture I wanted to order. It took several minutes before I got somebody in microbiology who knew what they were talking about to give me an answer." He emphasized that doctors have very little time to spare hanging on the phone or being transferred to several people to receive simple guidance.

 

Another physician pointed out that many physicians are not even aware that the lab might have high-level resources to help them when they need it. Labs need to make it known when they offer such services, he emphasized.

 

It seems, therefore, like labs need to offer consultative services, make it known to physicians that such services exist and also make the process more convenient and efficient.

 

Several analysts discussed the use of information technology (IT)  to automate certain functions that would both facilitate consultation and force physician behavior towards better utilization management.

 

Areas in which IT could be useful include reflex testing, trending, interpretive comments and physician order entry (POE) with electronic prompts (test definitions, suggestions, soft  stops and hard stops).  These require medical staff leadership upfront but, once in place, can provide valuable education and  help to manage behaviors basically on auto-pilot.

 

One interesting concept discussed by co-author Paul Epner, a consultant interested in the link between lab services and patient outcomes, is that of offering trend reports of various providers. For example, IT can easily track and compare the ordering practices of various providers. Do all cardiologists in a practice order tests with the same frequency? Does one order CKMB while the others order troponin? Does one physician order expensive reference tests which could be done on an outpatient basis? Who orders daily profiles when individual tests would suffice? Physicians can be pretty competitive and critical, so this type of report can help in guiding test utilization as well.

 

Every laboratory should monitor physician calls: what do they want to know? What do they seem to have most problems with? How fast does the lab resolve physician concerns? Are resources available in terms of best-practices literature or an expert in the laboratory? These are always prime areas where stepping up and offering help would be appreciated and contribute to physician satisfaction as well as better patient care.

 

So according to this survey, there is concrete proof that physicians do need our help, and would  gladly consult with us. In fact most would be grateful for our help. But we have to stay current in MLS to be comfortable providing factual information, we must be willing to help, we must make it known to physicians that help exists, and we must respond to requests (or evidence of knowledge deficit) in a timely manner. Since we are all busy, we should utilize automated aids when possible. In both the short and long term, IT is a powerful, but vastly underutilized, arrow in our quiver.            

 

2 comments

It seems that experiences always occur in groups. Recently I had 3 separate but similar experiences that

November 3, 2014 5:45 PM

Good ideas. As a young person in the profession, I am frustrated that we are not allowed to be all we can be. We have the best  and latest knowledge and lots of enthusiasm.  If the old folks are too tired or lazy to act like scientists,  then let us take the reins. Many of us would answer questions but fear being reprimanded or getting in trouble if we speak up.

Thank you for sharing these wise words.

Deronte Taylor August 26, 2014 12:59 PM
Pensacola FL

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