All Case Examples

Dr. Karim Sirgi explains why pathologists are often invisible to patients, hospital administrators, and even some physician colleagues, despite the fact that 70% of medical decisions are made only after lab tests have been obtained. He also offers pathologists strategies for making their role and value known.

The Laboratory Stewardship Committee at PeaceHealth, a community-based healthcare system in the Pacific Northwest with hospitals and clinics in Oregon, Washington and Alaska, spearheaded efforts that have delivered savings of $2.25+ million for patients each year after discontinuing procalcitonin testing—and an additional $1.6+ million in gross annual patient savings by changing in-house testing menu to guide providers towards ordering troponin I for acute myocardial infarction.

Thanks to the efforts of the Laboratory Stewardship Committee at Cleveland Clinic, the hospital system has saved over $8.5 million in laboratory test-related costs since 2011. Committee co-chairs Anita J. Reddy, MD, MBA, and Walter H. Henricks, MD, FCAP, detail 10 strategies other hospital and health care systems can employ to establish their own Laboratory Stewardship Committees—or improve the efficacy of their existing committees.

Brian R. Jackson, MD, associate professor of pathology, University of Utah, and medical director for support services, IT and business development at ARUP laboratories, offers this emphatic, clear-cut advice to hospital systems interested in establishing effective Laboratory Stewardship programs. According to Dr. Jackson, clinical integration and collaboration are essential: “If you get that clinical collaboration piece right—with pathologists working closely with frontline clinicians and hospital leadership—everything else can fall into place”—as long as the financial measurement system is supportive.

Gaurav Sharma, MD, FCAP, medical director of Department of Pathology and Laboratory Medicine Regional Laboratories at Henry Ford Health System in Detroit, was asked to improve relationships with clinicians and provide them with a consistent user experience through a well-thought-out governance and communication framework. Dr. Sharma discusses the formal infrastructure created for connecting clinicians and laboratory professionals from the ground up. He believes it has delivered real value between clinicians and laboratories.

From its earliest years, the CAP has fostered a culture of partnership and collaboration that embraces members, staff, clinical partners, health care executives, government agencies, and many others. Collaboration always has been an important quality driver in the CAP’s hallmark proficiency testing and accreditation programs. The CAP innovated once again in 2008 with the launch of a laboratory improvement program to offer CAP accreditation to the ISO 15189 standard: CAP 15189. This accreditation program creates a quality culture meant to connect the dots between risk management and quality improvement.

As the former president of the Spartanburg Regional Healthcare System medical staff and more than 10 years experience as a pathologist and microbiology laboratory medical director, Amy Christine Baruch, MD, MHCDS, FCAP, is a good fit as the chair of its medical executive committee. Since mentorship seems to be woven into the fabric at Spartanburg, she is always thinking about paying it forward, which may explain her inclination to press for ways to boost efficiency and economy along with morale.

Janis Atkinson, MD, FCAP, the medical laboratory director at AMITA Health Saint Francis Hospital in Evanston, Illinois, worked with a systemwide group of executives, quality experts, and clinicians to significantly improve quality through optimizing laboratory testing and leveraging the electronic medical record.

When Joseph Khoury, MD, FCAP, works with a new medical laboratory at an affiliate institution that is joining the MD Anderson Cancer Network, he is part of a multidisciplinary team taking steps to help improve quality by identifying potential process gaps, thriving on the mutual exchange of ideas that ultimately benefits patients and the public within that community.

Molecular diagnostics enable hospital-based laboratories to provide high-impact patient care services that protect and promote the quality and safety of patient care. Pathologist Karen L. Kaul, MD, PhD, FCAP, discusses why some of the emerging uses of molecular diagnostics at NorthShore University HealthSystem are efficient and cost effective and provide value to both the patient and institution.

Partners HealthCare is finding success in fully integrating its 11 hospitals by following a path of collaborative problem solving that encourages creative thinking for more economical, efficient, patient-centered care. As a part of the Partners network, Newton-Wellesley Hospital’s pathologists share the laboratory team’s ideas at a variety of medical staff meetings. Michael J. Misialek, MD, FCAP, recounts how the laboratory billing staff was integral in reducing waste, cost, and unnecessary testing.

Cleveland Clinic’s Laboratory Stewardship Committee uses a multidisciplinary team approach that draws upon resources and personnel within the hospital information system, laboratory, and clinical staff to improve patient care. Laboratory test utilization initiatives introduced since 2011 have saved the Cleveland Clinic $5.0 million—the cost avoidance in 2017 alone was more than $835,000. This teamwork approach has brought best practices and systemwide changes to bridge the connection between systems that work, patient safety, and improved patient care.

Leaders in pathology education scramble to design curricula that keep pace with the science of medicine without losing sight of either their trainees’ need for hands-on experience or the practical constraints that limit the flexibility of their clinical and administrative partners. One program director offers a snapshot of not-unwelcome challenges pathologists in training and their educators encounter. Can reframing pathology training benefit patients, colleagues, and administrators?

Identification and treatment of vitamin D deficiency is important for musculoskeletal and extra-skeletal health. For serum vitamin D testing of at-risk populations, there are well-defined clinical indications, including osteoporosis, malabsorption, fracture, limited effective sun exposure, obesity, and institutionalized individuals, among others. In these individuals it is appropriate to measure vitamin D to determine the dose of oral vitamin D supplementation to reach target levels. Repeat testing to ensure replenishment is also warranted.

Because standards and practices—second nature to pathologists—are so readily scaled up and transferred to other domains, pathologists are well prepared to take on broad, interdisciplinary roles. The career path of Stephanie Mayfield Gibson, MD, FCAP, into population health illustrates how pathologists’ roles are evolving and are poised to accelerate.

Using metrics to pivot for change, Amanda E. Haynes, DO, FCAP, collaborated with her team to motivate a system-wide effort that saved more than $1 million in blood acquisition costs across Pennsylvania’s Geisinger Health System.

Finding ways to monitor and manage the constant stream of information that may or may not be actionable to clinicians is a prime focus for Cordelia E. Sever, MD, FCAP, and her team at Pathology Associates of Albuquerque. They are coming to grips with the need for more refined, targeted, and dynamic information management that benefits interspecialty collaboration—and the patient.

The Outpatient Cytopathology Center in Johnson City, Tennessee, grew into a thriving business, attributed in large part to its concentrated focus on pathologist-led services that integrate clinical care and prompt reporting of test results. CAP member Susan D. Rollins, MD, FCAP, and her two partners deliver a distinct value to patients and referring physicians alike in which FNA and surgical biopsies are among the services they perform and interpret.

As a systems-oriented physician, Alexis Byrne Carter, MD, FCAP, uses her pathologist’s curiosity and clinician’s interest in how people think as she observes, evaluates, and negotiates on behalf of patients to remove ambiguity in systems and processes.

Ebola Virus Disease put the biocontainment facility at Emory University Hospital to the test and put an emphasis on team integration and safety procedures.