Improvement in Physician's Office Laboratory Practices, 1989–1994 (original) (raw)
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The Physicians' Office Laboratory
Archives of Pediatrics & Adolescent Medicine, 1998
Objectives: To contrast practices of physicians' office laboratories in the years 1988 and 1996 and ascertain physicians' perception of the effect of the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Design: Mailed surveys to members of the Illinois chapter of the American Academy of Pediatrics in 1988 and 1996. Subjects: There were 525 and 980 respondents in 1988 and 1996, respectively; analyses included 282 and 374 surveys representing offices where direct patient care was provided in a nonhospital setting. A paired analysis was also conducted on 101 offices that responded to both surveys. Results: There was a decline from 1988 to 1996 in the percentage of offices doing in-office laboratory testing (93% to 84%, respectively; 2 test; P<.01) and median number of types of tests (6 tests vs 4 tests; Mann-Whitney U test; P<.001). Decreases (2 test; P<.01) were seen in the proportion of offices offering throat culture for group A streptococci (63% to 33%), urinalysis (54% to 33%), urine culture (53% to 22%), rapid hemagglutination slide test for mononucleosis (42% to 17%), the-ophylline level (27% to 4%), and total cholesterol (22% to 13%). The proportion of offices offering urine dipstick, hematocrit or hemoglobin, complete blood cell count, and stool occult blood tests remained stable. For solo practitioner offices only, streptococcal antigen detection testing decreased (66% to 39%; 2 test; P<.001). Findings in the paired analyses were similar. In 1996, more offices participated in a formal proficiency testing program (60% vs 11%; 2 test; P<.001). The CLIA guidelines were deemed responsible for increased documentation (58%), discontinuing 1 or more tests (56%), increased frequency of quality control (50%), joining a proficiency program (40%), and increased cost to patients (32%). Conclusions: These surveys provide large-scale data concerning change in office-based laboratories of physicians serving children during an 8-year period. Office laboratories reduced their menu of tests and enhanced documentation and quality control for the tests that were done. Data like these in multiple specialties over time contribute to a comprehensive picture of the effects of CLIA on office laboratory practices.
In Support of Quality and Safe Patient Care: Defining the Value of Laboratory Medicine
American Society for Clinical Laboratory Science, 2019
spanning the breadth of the field of laboratory medicine came together to form the Coordinating Council on the Clinical Laboratory Workforce (CCCLW) with a threefold mission 5 : • To increase the number of qualified clinical laboratory professionals. • To enhance the image of clinical laboratory professionals. • To increase healthcare and public awareness of our value in achieving positive patient outcomes. A first step in promoting the value of laboratory medicine in patient care and outcomes entails the development of interventions that make a positive difference accompanied by measures that are sensitive to the incremental benefit. 6 Accepted measures of value that laboratory medicine
Journal of Multidisciplinary Healthcare
Background: The use of diagnostic laboratory tests is increasing worldwide. Improper test utilization (ITU) is a common problem for all healthcare systems as it costs substantial expenses for the health systems and impacts optimal patient care. Purpose: The present small-scale survey aims to highlight the current practice of ITU among the labs and physicians, and investigate the actions of diagnostic laboratories towards ITU, and identify the reasons affecting test ordering decisions among physicians. Methods: A cross sectional study based on two different surveys was developed and distributed from March 2017 to April 2017 to laboratory supervisors and physicians (clinicians) at Hamad Medical Corporation (HMC), Qatar. Fourteen laboratory supervisors and eighty-nine physicians were surveyed about improper test utilization practices. The overall results are descriptive data. Results: The overall proportion of improperly utilized tests detected by the laboratory supervisors were 50.0%, 35.7%, and 14.3% for overused, misused, and underused lab tests, respectively. Among the physicians, 91% used the electronic ordering template to select the appropriate tests. Moreover, 78.7% of the physicians used the clinical guidelines, while 73% were not employing the laboratory handbook. Furthermore, 95.5%% of the physicians preferred to get feedback about inappropriate tests, while 51.1% were not receiving any, and 40.9% were rarely receiving. Finally, 67.4% were unaware of the tests' costs among surveyed physicians, and 63.6% showed a willingness to reduce their orders if the cost was high and unnecessary. Conclusion: The physician's and the laboratories' communication were inadequate and not systematized, causing ITU practices. The improvement strategy should focus on the communication between clinical labs and physicians and enhance physician implementation to order appropriate lab tests. This could be achieved by conducting legitimate educational methodologies, continuous feedback reviews, ongoing audits, executing health information technology instruments, engaging laboratory practice guidelines, and applying demand management and testing algorithms.
Doctors' perceptions of laboratory monitoring in office practice
Journal of Evaluation in Clinical Practice, 2010
Background Laboratory monitoring has been increasingly recognized as an important area for improving patient safety in ambulatory care. Little is known about doctors' attitudes towards laboratory monitoring and potential ways to improve it. Methods Six focus groups and one individual interview with 20 primary care doctors and nine specialists from three Massachusetts communities.
International Journal for Quality in Health Care, 2005
Background. Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement. Objective. To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization. Design. An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention.
Clinica Chimica Acta, 2013
Background: Point-of-care laboratory testing (POCT) offers reduced turnaround time and may facilitate medical decision-making and improve clinical operations. However, there is very little published data concerning the impact of POCT on patient satisfaction. Methods: We implemented POCT for hemoglobin A1c, lipid panel and comprehensive metabolic panel in a primary care practice and monitored patient satisfaction with on-site testing using an anonymous survey. Results: A total of 97 surveys (65% response rate) were reviewed. On a scale of 1 (poor) to 4 (excellent) the mean response to the question "Compared with your past experiences of physician office visits that did not have on-site testing please rank your overall level of satisfaction with today's office visit" was 3.96. In 34 surveys a free text comment was included which was uniformly very positive. Conclusions: Our study strongly indicates a high level of patient satisfaction with on-site POCT in a primary care setting.
Archives of pathology & laboratory medicine, 2016
Context.-Assessment of customer satisfaction is a vital component of the laboratory quality improvement program. Objective.-To survey the level of physician satisfaction with hospital clinical laboratory services. Design.-Participating institutions provided demographic information and survey results of physician satisfaction, with specific features of clinical laboratory services individually rated on a scale of 5 (excellent) to 1 (poor). Results.-Eighty-one institutions submitted 2425 surveys. The median overall satisfaction score was 4.2 (10th percentile, 3.6; 90th percentile, 4.6). Of the 16 surveyed areas receiving the highest percentage of excellent/good ratings (combined scores of 4 and 5), quality of results was highest along with test menu adequacy, staff courtesy, and overall satisfaction. Of the 4 categories receiving the lowest percentage values of excellent/good ratings, 3 were related to turnaround time for inpatient ''STAT'' (tests performed immediately), outpatient STAT, and esoteric tests. The fourth was a new category presented in this survey: ease of electronic order entry. Here, 11.4% (241 of 2121) of physicians assigned below-average (2) or poor (1) scores. The 5 categories deemed most important to physicians included quality of results, turnaround times for inpatient STAT, routine, and outpatient STAT tests, and clinical report format. Overall satisfaction as measured by physician willingness to recommend their laboratory to another physician remains high at 94.5% (2160 of 2286 respondents). Conclusions.-There is a continued trend of high physician satisfaction and loyalty with clinical laboratory services. Physician dissatisfaction with ease of electronic order entry represents a new challenge. Test turnaround times are persistent areas of dissatisfaction, representing areas for improvement.
The American Journal of Medicine, 2017
BACKGROUND: Overutilization of clinical laboratory testing in the inpatient setting is a common problem. The objective of this project was to develop an inexpensive and easilyimplemented intervention to promote rational laboratory utilization without compromising resident education or patient care. METHODS: The study comprised of a cluster-randomized, controlled trial to assess the impact of a multifaceted intervention of education, guideline development, elimination of recurring lab orders, unbundling of laboratory panels, and redesign of the daily progress note on laboratory test ordering. The population included all patients hospitalized on a general medicine service during two consecutive months on a general medicine teaching service within a 999-bed tertiary care hospital in Boston, MA. The primary outcome was the total number of commonly utilized laboratory tests per patient-day during two months in 2008. Secondary outcomes included a subgroup analysis of each individual test per patient-day, adverse events, and resident and nursing satisfaction. RESULTS: 5392 patient-days were captured. The intervention produced a 9% decrease in aggregate laboratory utilization (rate ratio 0.91, p = 0.021, 95% CI 0.84-0.98). Six instances of delayed diagnosis of acute kidney injury and 11 near misses were reported in the intervention arm. CONCLUSIONS: A bundled educational and administrative intervention promoting rational ordering of laboratory tests on a single academic general medicine service led to a modest, but significant decrease in laboratory utilization. To our knowledge, this was the first study to examine the daily progress note as a tool to limit excessive test ordering. Unadjudicated near misses and possible harm were reported with this intervention. This finding warrants further study.