Maximizing Value: Establishing a Hospital Clinical Laboratory Utilization Committee

Laboratory testing is used across all care settings and specialties for screening, diagnosis, and disease management. As such, it is an inherent part of the health care system. Unfortunately, not all testing is appropriate. Inappropriate testing consumes limited labor and supply resources and increases the potential for additional interventions which can increase costs and reduce patient outcomes.

There’s a significant opportunity for today’s hospital laboratory professionals to refocus the value they bring to their organizations beyond maintaining test quality and fulfilling laboratory orders. Establishing a Clinical Laboratory Utilization Committee, modeled after a Pharmacy and Therapeutics Committee, is a great way to improve patient diagnosis and management and reduce healthcare costs.

The role of the hospital pharmacist: a model worth exploring

When you consider the role of hospital pharmacists, it clearly extends beyond simply maintaining drug inventories and fulfilling orders. We know it is not feasible for a pharmacy to stock every drug in every formulation that a physician might order; neither is it in patients’ best interests for pharmacists to simply fulfill any orders they receive. Typically, pharmacists assist physicians in dosage management and suggesting alternative therapies. Pharmacies play an important role in managing costs by substituting generics and/or more effective therapeutics where appropriate and by managing inventory costs effectively.

Hospitals’ Pharmacy and Therapeutics Committees serve as a formal link between pharmacy and medical staff, providing the structure to allow a team of pharmacists and physicians to leverage their expertise for improving patient care. The objective of these committees is to determine drugs of choice and any alternatives based on the latest information; minimize redundancies and maximize cost-effectiveness. These committees oversee what drugs the pharmacy stocks, when it is permissible to substitute generics and whether any of the drugs have special rules associated with ordering. An example of the latter might be an expensive antibiotic that might be available, but only with the permission of infectious disease specialists or a pathologist.

Now let’s take that model and apply it to the hospital laboratory.

Implementing a clinical laboratory utilization committee

As with the pharmacy model presented above, the role of today’s laboratory professional can and should extend beyond validating and maintaining test quality and fulfilling laboratory orders. It should include determining what test methodologies will be offered and how they will be delivered, i.e., central testing, near-patient testing, point of care testing, or outsourced to an independent reference laboratory.

As part of a demand management program, a Clinical Laboratory Utilization Committee can provide the governance framework that helps establish a partnership with medical staff so that laboratory leaders can leverage their expertise to help prioritize clinical relevance. Typically, the group will include physicians and scientists such as the chief pathologist/chief science officer, microbiologist, chemist, or another scientist.

Though there’s a wide range of models for these committees, successful committees have a few things in common: the support of hospital leadership, the active involvement of medical staff, include committee membership from multiple specialties, and IT resources needed to access utilization data and implement any changes.

A laboratory scientist will bring the committee an analysis of which laboratory tests were used during a recent window of time. Leverage available sources of such information, such as laboratory information system orders, reference lab usage, HIS reports or Vizient tools. Look for red flags such as:

• Obsolete tests on the laboratory’s test menu
• Frequent ordering of an older test when a newer, better test (with respect to cost and/or accuracy) is available
• Ordering of daily routine labs
• Order sets for broad disease test panels which haven’t been updated for diagnostic utility

Members of the committee will leverage their training, scientific and evidence-based medical literature, data collection, knowledge of physician ordering behavior, test profiles and order entry tools to determine tests that may be archaic or underused. The committee works to identify patterns in test ordering and develops a list of appropriate laboratory tests. Those recommendations can be used in communications with the medical staff, tracking of test ordering patterns, in the computerized provider order entry or a laboratory formulary.

In addition to deciding the ‘what’ and ‘how’ of laboratory tests to be offered in the laboratory formulary, guidance must be established that defines what tests can be ordered and any limitations or restrictions. Given the thousands of laboratory tests available, it is not realistic to expect physicians to stay up to date on the most current recommended ordering practices. Educating physicians on the latest medical literature combined with a data-driven approach will establish a collaborative relationship with the medical staff, enabling an open dialogue. Further support is gained by sharing the policy with the chief financial officer or designee, chief medical officer and other roles that are interested in high utilizers of laboratory services. The example of a governance group’s work to address high-level use of the cardiac marker test CK-MB is an approach that has had success in hospitals interested in maintaining current practices in diagnostics.

Today’s ever-increasing focus on cost control, operational effectiveness and performance metrics in the clinical laboratory industry presents an opportunity for laboratory leaders to elevate their roles in promoting high-quality, cost-effective clinical care. Doing so can bring added value that contributes positively to the success of the organization.

Test demand management is recognized by accrediting agencies and The Clinical and Laboratory Standards Institute (CLSI) published a guide to developing and managing a medical laboratory test utilization management program. If you need assistance developing a clinical laboratory utilization committee or developing a demand management strategy, feel free to reach out to us for assistance.