What Do Doctors Want from the Laboratory- Part 2?
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.
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.
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
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.
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
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.
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.
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.
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.
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.