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This project seeks to achieve voluntary consensus on a set of effective, well-specified patient safety and communication practices for the pre- and post-analytic stages of laboratory diagnostic services.
The laboratory is an integral part of the continuum of care. According to data from the Centers for Medicare and Medicaid Services, laboratory charges are incurred in 98% of all hospital admissions1. The Mayo Clinic has estimated that 60%-70% of critical patient care decision-making—e.g., admittance, discharge, medication management—involves laboratory results2. These statistics highlight the extent to which diagnostic tests inform patient care and influence health outcomes. Because laboratory medicine provides information vital to clinical decision-making across the spectrum of patient populations, provider types, and care settings, assuring quality at every stage of testing is of key importance to furthering the goal of high-quality healthcare.
The laboratory community has a long history of engaging in quality improvement initiatives (e.g., LEAN, SixSigma, Q-PROBES, Q-TRACKS). However, quality improvement in the pre- and post-analytic phases of testing—key stages of communication between the laboratory and other entities—extends beyond the laboratory to care providers ordering tests, collecting specimens, and receiving test results. In a review of errors and patient safety events involving diagnostic services, error rates were higher in the pre- and post-analytic stages than during the actual analytic testing stage,3 indicating a significant opportunity for quality improvement. In 2006, NQF held a workshop and a commissioned paper on defining value and quality in laboratory medicine; conclusions highlighted that pre- and post-analytic phases are critical leverage points for patient safety due to the level of communication and shared responsibility across entities and the resulting potential for error.
This project will focus on preferred practices for communication and information transfer during the pre- and post- analytic stages of testing, with a special focus on practices that leverage information technology and address the interface between laboratory information systems and information systems used in other care settings. For the purposes of this project, ‘laboratory diagnostic services’ will refer to all aspects of laboratory services, including anatomic, clinical, and molecular pathology, transfusion medicine, immunochemistry, cytology, hematology, microbiology, genetic testing, and other in vitro diagnostics. Since laboratory services occur across multiple care settings, practices focused on all care settings and all care providers will be considered.
Funding for this project has been provided by the Centers for Disease Control and Prevention. For more information, contact Nicole Williams-McElveen, MPH, at (202) 783-1300 or email your questions to labpractices@qualityforum.org.
1Medicare and Medicaid Statistical Supplement, 2003. Available at http://www.cms.hhs.gov/MedicareMedicaidStatSupp/LT/itemdetail.asp ?filterType=none&filterByDID=-99&sortByDID=1&itemID= CMS060512&intNumPerPage=10. Last accessed August 2007.
2Forsman, RW Why is the laboratory an afterthought for managed care organizations? Clinical Chemistry. 1996; 42(5):813-816.
3Howanitz, J. Errors in Laboratory Medicine: Practical Lessons to Improve Patient Safety. Arch Pathol Lab Med. 2005;129:1252-1261.