It’s been said that the best healthcare decisions are made when all of the relevant information is known and considered by all healthcare team members. This includes everyone from physicians to nurses to laboratory staff and patients themselves, in addition to medical records, diagnostic test results, and clinical data gathered by the healthcare team at each point during the patient’s treatment cycle.
Laboratory Medicine plays an integral role in this process by providing information that helps support patient care throughout every stage of the treatment cycle, whether before surgery or after diagnosis, but especially during procedures with complex outcomes.
This blog will explore how Laboratory Medicine supports direct patient care and the status of Medical Laboratory services in the 21st Century.
What Is Laboratory Medicine?
Laboratory Medicine is the branch of medicine that deals with diagnosing and treating disease using laboratory tests. It plays a vital role in direct patient care, as it helps doctors to make decisions about diagnosis and treatment. In many cases, laboratory tests are the only way to confirm a diagnosis.
The Medical Laboratory is the core for new drug and treatment clinical trials. Medical laboratories can also produce blood products like plasma or red blood cells for transfusions and test infectious diseases like HIV or hepatitis C.
Laboratory testing has advanced immensely, especially in the last couple of years, with advancements in complex testing methodologies and computer-run instruments.
Increasingly, laboratory services are needed to improve patient care. To achieve patient-centered and evidence-based care, laboratory professionals must play a more direct role in healthcare teams comprising pharmacists, physicians, nurses, and other healthcare experts.
Labs and the Continuum of Care
Labs play an important role in the continuum of care by providing diagnostic and prognostic information. This information can help guide treatment decisions and improve patient outcomes. In addition, labs can guide disease surveillance and outbreak control.
- Lab professionals can ensure that patients receive the best care by working collaboratively with other healthcare team members. Lab professionals are increasingly involved in caring for hospitalized patients. A primary goal is to assess a patient’s risk for infectious diseases and prevent transmission within the hospital environment.
- Lab staff may consult on antibiotic therapy and offer assistance with obtaining appropriate cultures and antibiograms. For instance, when a patient has suspected or confirmed Clostridium Difficile Infection (CDI), lab staff will often initiate contact isolation precautions or provide antibiotics if the clinician orders.
- Lab staff also have an active role in preventing CDI recurrence by testing stools from patients with CDI. In addition, they work closely with clinicians and nurses to provide timely diagnoses, assess the need for additional testing, and determine appropriate antimicrobial treatments.
Sometimes, clinicians may ask lab personnel to collect specimens from a patient before surgery. These pre-operative tests may include blood count, electrolytes, erythrocyte sedimentation rate (ESR), erythrocyte volume indices (EVIs), coagulation panel and glucose.
Such tests can detect pre-existing medical conditions or complications that might occur during the surgical procedure. Additionally, pre-operative tests are useful in assessing a patient’s response to anesthesia medications which could alter laboratory results postoperatively.
Clinical Applications of Lab Medicine
From diagnosing infectious diseases to monitoring diabetes, lab medicine plays a critical role in direct patient care. And while most people think of the laboratory as a place where tests are done on blood and other bodily fluids, there is much more to it. Laboratory Medicine supports direct patient care in several ways in the clinical setting. These include:
- Without lab medicine, many diseases would go undetected and untreated.
- First and foremost, diagnostic testing helps clinicians make more informed decisions about patient care.
- Additionally, lab results can be used to monitor patients for disease progression or response to treatment.
- Research conducted in the laboratory can lead to new and improved patient treatment.
- Lab medicine can monitor patients for therapeutic drug levels and screen for potential drug-drug interactions. One such example is the use of bone marrow biopsies to detect abnormalities before leukemia symptoms develop. Another example is cardiac catheterization to assess coronary artery function and obstructions before heart attack symptoms develop.
- Finally, by using Laboratory Medicine to support direct patient care, healthcare professionals can achieve faster turnaround times in determining the correct diagnosis and provide a higher quality of care.
Patient Safety and Health Outcomes
Clinical laboratory services broadly apply to one of the leading types of healthcare diagnostics. Medical Laboratory professionals, custodians of patient safety, play a key role in a team-centered practice grounded in the medical community’s culture of patient safety and quality.
The culture encompasses the tenets of safe, effective, patient-centered, timely, efficient, and equitable practice, according to the National Academy of Medicine (NAM) (formerly the Institute of Medicine).
The clinical laboratory provides services that improve medical diagnostic processes and patient health outcomes. This process is made possible by:
- Precise and timely diagnosis.
- Practice patient-centered care; understanding the patient is the focus of the practice.
- Facilitate and support change using evidence-based laboratory practices.
- To reduce error, improve service delivery, and apply quality improvement principles to processes.
- Utilize IT and software to promote better communication and offer safe and efficient healthcare services.
- Serve as a key part of collaborative, interprofessional healthcare activities for designing and implementing innovative and improved healthcare services.
From Laboratory-Related Errors to Diagnostic Errors
One of the main goals of Laboratory Medicine is to support high-quality patient care. To do this, laboratory professionals work hard to ensure that diagnostic testing is accurate and reliable. However, errors can still occur.
Studies have estimated that diagnostic errors account for about 5% of hospital adverse events. While some errors are human, others can be traced back to problems with the system or process itself.
For example, when a laboratory technician uses the wrong reagents or instruments to perform tests, these errors could lead to incorrect results. The National Academy of Medicine estimates that patients are involved in one diagnostic error at some point. These errors may not always be obvious but can lead to health consequences if left untreated. If a disease goes undetected because of lab error, it may cause irreversible damage before being detected.
Laboratory testing consists of three phases: pre-analytical (collection and storage of specimens, where approximately 68% of errors occur), analytical (laboratory testing, where approximately 13% of errors occur) and post-analytical (where approximately 47% of errors occur). The variables in the pre and post-analytical phases directly impact accuracy and precision in the analytical phase.
In expedited turnaround time (TAT), quality assurance (QA) and quality control (QC) of laboratory testing are incoherent if the incorrect test result is ordered/re-ordered and is not interpreted or read accordingly.
It is vital to understand the type, frequency, causes, and impact of errors on patients to identify and implement control measures to prevent failures and reduce risk. Laboratory testing has changed over time as the definition of the laboratory testing process itself, and the organizational methods of medical laboratories have evolved.
Development of Diagnostic Management Teams (DMTs)
Better prevention of errors during specimen collection and diagnosis of these errors during laboratory analyses would lead to quicker patient recovery, better treatment times, reduced expenses, and an overall improvement in patients’ health.
To help with this goal, a Diagnostic Management Team (DMT) was created. This DMT comprises doctors who provide direct patient care and expertise in laboratory diagnosis, medical treatment, and other specialties.
DMTs are teams of health care providers who work together to diagnose and treat patients. The team approach leads to positive clinical results for patients with shortened hospital stays and treatment time.
In addition, DMTs help ensure that patients receive the best care by coordinating care between specialists. For example, patients may need surgical and medical management for their condition. Therefore, a surgeon might consult with a medical specialist, or a medical specialist might consult with a surgeon to better determine how best to manage the patient’s condition.
Furthermore, because many patients have multiple diseases or conditions simultaneously (comorbidities), a DMT is often needed to manage these complex cases. An example of this would be an individual with diabetes who has also been diagnosed with hypertension.
Their blood pressure will not stabilize until they control their sugar levels. Therefore, a diabetologist must participate in the DMT to effectively manage this patient’s disease state.
So DMTs are grouped based on the disease state, and contributors are mostly clinical physicians and pathologists. However, there are also contributions from pharmacists, nurses, and laboratory scientists.
An expert team specifically assists in ordering various lab tests and interpreting different results to ensure diagnosis can be determined effectively and accurately.
As a result of expertise-driven algorithms that include reflex testing and are updated regularly, the Development of Diagnostic Management Teams can easily review and control laboratory testing to prevent overuse and underuse.
Furthermore, laboratory data are then compared to the patient’s medical record for a clinical interpretation. DMT has been used in coagulation, transfusion medicine, lymphoma, and infectious diseases to improve diagnosis time and accuracy.
The Evolution of Medical Laboratory Services
In ancient times, doctors had to perform all the tests themselves, most often by collecting a sample of blood or urine and performing a test. The physician would then interpret the results and make a diagnosis.
Today, laboratory testing is performed by trained medical technologists and technicians in hospitals, clinics, and independent laboratories. Physicians interpret the results of these tests to help make diagnoses and determine treatment plans.
Medical Laboratory services have evolved from predominantly an indirect service that provides the only interpretation of data collected by others to an integral part of direct patient care. Medical lab professionals also work with other health care providers to establish conditions such as anemia, clotting disorders, kidney disease, diabetes mellitus, hepatitis B and C, AIDS/HIV infection and more.
Today, about 13 billion tests on various specimens (urine, saliva, blood) are performed annually in the United States, making up roughly two-thirds of all clinical laboratory testing done yearly. In addition, nearly 8 million patients may have their specimens analyzed at a hospital or clinic laboratory on any given day.
The ability to quickly process large numbers of specimens has been facilitated by the development of automated systems using robotics and microfluidics that perform diagnostic screening assays on samples for common infectious agents such as viruses, bacteria, parasites, and fungi.
A comprehensive range of specimen types (blood, urine, saliva) can be tested for various diseases and metabolic abnormalities. Plus, treatments can be monitored through periodic therapeutic drug levels.
In addition, certain diseases can be screened for before the onset of symptoms; genetic analyses can identify risk factors for certain diseases, and sophisticated instrumentation allows scientists to investigate specific molecules involved in human health.
Laboratory Medicine: The Future of Healthcare
Laboratory Medicine supports direct patient care by providing essential information about the patient’s condition. This information helps guide treatment decisions and ensures that the care provided is appropriate and effective.
By working with Laboratory Medicine, clinicians can provide the best possible care for their patients. They use this information to make sure they are diagnosing and treating conditions appropriately. And if needed, they may order additional tests or refer the patient to a specialist to get all the necessary information before making a diagnosis or treatment plan.
Clinical laboratories also help ensure that certain diagnostic tests are performed correctly, so there is no room for error. Working together, Laboratory Medicine is important in supporting direct patient care and ensuring quality health care.
To truly accomplish personalized medicine, laboratory professionals in the clinical laboratory must be included in the health care team. Continued advances in Laboratory Medicine will enable doctors and patients to better determine the risks and benefits of care options and to tailor health management strategies to ensure that individual health and quality of life are optimized.
Dr. Stephen E Fry and his team provide a variety of specialized tests that can help diagnose conditions such as leukemia, anemia and more. In addition, we offer lab testing services at an affordable price. If you’re interested in medical laboratory services, please contact us.