Several masked laboratorians posing for a picture

Andrew Fletcher, MD, wants laboratorians to consider their huge impact on healthcare delivery, quality, and cost in hospitals and healthcare systems.

His 2022 AACC Annual Scientific Meeting roundtable session, “Demonstrating the Value of Clinical Laboratory Medicine: Partnership with Case Management,” will help laboratorians realize and effectively articulate their worth as many managers worry about buy-outs and new owners contracting out for laboratory services.

Partnerships between labs and case management are a key to improving care and lowering costs, said Fletcher, founder of the newly established Eutiologic Consulting and former physician advisor and medical director of consultive services at ARUP Laboratories in Salt Lake City. He got his start working with case management as a hospital lab director tasked with reducing the largely uncompensated time patients spent under observation. Like observation patients in other hospitals, a majority had chest pain and myocardial infarction (MI) evaluations.

Fletcher got an idea after hearing phlebotomists complain about drawing chest pain patients’ blood every 8 hours. If they were right, the status quo ran afoul of clinical guidelines that call for laboratory testing for cardiac troponin at the time of a patient’s first assessment and repeat testing 3 hours later. Meanwhile, a Centers for Medicare & Medicaid Services (CMS) rule defines the acceptable observation period for patients as “across 2 midnights.”

Fletcher decided to review groupings of ED orders intended to standardize and expedite the ordering process for specific clinical scenarios. Typically, labs do not see these order sets. He saw that the phlebotomists were right. “Patients were getting inappropriate care and the result was a 16-hour [partially uncompensated] length of stay,” said Fletcher. In response, Fletcher helped the case management department and ED institute a more appropriate, timely troponin ordering and testing protocol, which shortened observation stays.

Roundtable attendees will learn how similar collaborations with case management departments can help drive proper ordering, sample handling, and test performance, as well as institutions’ progress on quality goals and related metrics.

Two areas ripe for improvement are hospital-acquired infections for urinary tract and Clostridium difficile infections, which CMS always considers the hospital’s fault, Fletcher noted. In the case of urinary infections, contaminated samples can skew results and drive inaccurately high case counts. Diarrhea prompts test orders for C. difficile but may be inappropriate if diarrhea results from laxatives.

Laboratorians should set up systems for important and effective communication about inappropriate test orders. Labs should discuss them with case management and other departments. Doing so improves care, saves money, and reminds clinicians and administrators that laboratorians do much more than “crank out numbers,” Fletcher added.

“Working with case management highlights our role in medicine. Many people do not realize how many parts of healthcare the lab touches,” said Fletcher. “If we impact a large percentage of medical decisions, we impact a large percentage of healthcare delivery.”

He hopes to help laboratorians leverage laboratory data that produces actionable, clinical insight, and drives better healthcare and financial outcomes. Roundtable attendees will leave versed in how to take a broader approach to delivery of laboratory medicine at a system level and tweak tests to improve care in specific parts of the hospital and system.

He encourages laboratorians take advantage of how the COVID-19 pandemic has drawn public attention to their work and become more involved in conversations about improving care. “Labs have gained credibility and people are listening to us now. It is the perfect time for labs to step up and show how important we are and discuss wider problems in hospitals and health systems and other things we are a part of, including case management.”

Deborah Levenson is a freelance writer in College Park, Maryland. +Email: [email protected]