COVID-19 and the need for effective laboratory stewardship programs: 6 Qs with Seattle Children's Dr. Jane Dickerson

The COVID-19 pandemic has drawn unparalleled attention to the critical role of lab testing.

But along with increased attention, the pandemic has led to a tremendous increase in the demand for testing, putting pressure on labs to secure and manage necessary resources.

The current situation for labs highlights the importance of effective laboratory stewardship. As Jane Dickerson, PhD, director of chemistry and reference lab services at Seattle Children's Hospital and co-founder of the nonprofit PLUGS® (Patient-centered Laboratory Utilization Guidance Services ) told Becker’s Hospital Review, "Now, more than ever, we need to be good stewards, using laboratory resources in the right and most effective way."

Here Dr. Dickerson discusses the current landscape for laboratory testing, key elements of laboratory stewardship and what the future holds for the adoption of stewardship standards and for reimbursement.

Editor's note: Responses have been edited for clarity and length.

Be sure to check out the Becker's Healthcare & hc1 Precision Health Virtual Summit On-Demand to hear exclusive interviews and sessions with industry experts as they discuss the challenges and opportunities around value-based care and precision health in today's healthcare landscape. You can watch all summit sessions on-demand here.

Question: Can you briefly describe your role and the many hats you wear?

Dr. Jane Dickerson: I am based at Seattle Children's Hospital and I have a few roles in the laboratory. I am the medical director for our chemistry lab, as well as our reference lab services, which includes any testing we send out to other labs or testing that gets referred into our lab. I'm a medical director of a regional lab we are affiliated with. I'm the clinical director of PLUGS , a non-profit organization run out of the Department of Laboratories at Seattle Children's with about 95 member organizations. PLUGS' goal is to improve laboratory test stewardship throughout the country. And I am a clinical associate professor affiliated with the department of laboratory medicine and pathology at the University of Washington.

Q: How do you view the current landscape for laboratory testing?

JD: The current landscape is challenging and complex.

Due to COVID-19, the laboratory community is getting much more attention. This is great in some ways, but it comes with a lot of pressure. Having greater visibility — worldwide, nationally, locally and even within our own system — has allowed us to be more at the forefront of decision-making in a way we have always wanted, which has been positive.

But COVID-19 has presented safety and resource challenges.

Safety is always important, but it is even more important during COVID, since we are front-line workers working with infectious samples. This has affected our day-to-day operations in how we get samples and process tests. We are constantly assessing the risks and determining how to ensure safety.

Regarding resource challenges, the huge demand for COVID testing has strained all resources. It has been a challenge to get supplies for COVID tests. Then, because suppliers are putting their efforts into making COVID supplies, the rest of the lab has been second in line. As a result, we're not getting reliable supplies of polypropylene tubes, for example, that we use throughout the lab. It's a game of whack-a-mole trying to figure out what supply is delayed or not available, and then seeing what backups are available and if they need any extra validation. There's been a lot of stress related to securing the resources we need.

We have also been constrained in our people resources, forcing us to divert staff to different areas of the lab. Because of the attention of testing and labs, every lab is struggling with a constantly evolving game of prioritization. Which tests can we do? What supplies do we need? What people do we need?

Q: What are the elements of a successful laboratory stewardship program?

JD: Successful laboratory stewardship programs have four elements.

First is governance. That is the policies and procedures around a program. It includes stating who is doing the work and who are those people accountable to.

Second is the intervention. That is what you are doing and changing within your system to improve the lab.

Third is the data. A successful lab stewardship program requires ready-access to relevant data from your institution's system — including the EMR and the laboratory information system. Analysis of this data is necessary to identify where interventions are needed and to assess whether interventions are working.

Fourth is to review and improve. Effective laboratory stewardship is an ongoing process of continual improvement. It requires evaluating all aspects of the lab to see how everything is working and to identify areas where refinements are needed.

Q: Why are laboratory stewardship programs so important?

JD: They're important because laboratory testing is an essential resource, but it's not an unlimited resource. We have a finite set of people and money and supplies to do testing. So, we need to be good stewards of these resources and need to make sure we're doing testing in the right and most effective way, which supports best patient care. Stewardship is putting policies and procedures in place to optimize these resources and to give providers support for the tests they need.

Q: How do you anticipate that lab stewardship standards will evolve?

JD: Through PLUGS, we've converted the key elements for effective lab stewardship into a written set of standards, with an affiliated checklist. These standards and the checklist are tools that can be used by any institution on a voluntary basis. Labs can assess their stewardship program against these standards.

Our hope is these standards will become recognized by payers, CMS and other organizations as standards to be followed across the industry. Ultimately, we would like to see adoption of the standards lead to accreditation and better reimbursement.

Q: How can lab leaders achieve optimal payment for their services?

JD: The dream would be to tie it all together. Right now, we're very siloed. We have providers doing the best they can for their patients, individual hospitals doing the best they can for their population and payers getting data fed to them from various places and trying to make sense of it all.

We need better alignment. We need payers to recognize and fairly compensate the efforts taking place within labs, especially when they're meeting standards. We also need the clinical community to support the payers by having experts update policies on what lab tests are reasonable and medically necessary, and what are not, and identify and prevent fraud, waste and abuse of laboratory tests. Better alignment will provide benefits for labs, providers, payers and patients. It will make the entire system work better.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Whitepapers

Featured Webinars