Clinical Laboratory Stewardship Guidelines by the National Committee for Laboratory Stewardship Oct. 2017

NCLS Publication

13 Billion test performed Background 3 most significant causes of patient harm Ordering the wrong test Failing to retrieve a test result Misinterpreting a test result 13 Billion test performed 70% decisions based 10-30% unnecessary 13 Billion tests performed in US each year Approximately 70% of downstream decisions based on lab results 10-30% of lab tests are either unnecessary or inappropriate 3 most significant causes of patient harm Ordering the wrong test Failing to retrieve a test result Misinterpreting a test result

Trends in Healthcare Laboratory Stewardship Radiology Utilization management Blood Utilization Laboratory Stewardship Antimicrobial Stewardship Pharmacy Utilization management Blood Utilization Radiology Utilization management Laboratory Stewardship? Antimicrobial Stewardship Pharmacy Utilization management

National Committee for Laboratory Stewardship Commissioned in 2016 10 members from 7 academic institutions Medical Directors, Clinical Chemists, Medical Technologists Recommendation that integrated healthcare systems, independent hospitals implement laboratory stewardship programs Summarize the core elements of a successful hospital-based laboratory Stewardship program Compliments existing guidelines from Clinical Laboratory Standards Institute and Choosing Wisely Commissioned in 2016 10 members from 7 academic institutions Medical Directors, Clinical Chemists, Medical Technologists Recommendation that integrated healthcare systems, independent hospitals implement laboratory stewardship programs Summarize the core elements of a successful hospital-based laboratory Stewardship program Compliments existing guidelines from Clinical Laboratory Standards Institute and Choosing Wisely

Laboratory Stewardship – 4 Basic Elements Governance Interventions Data extraction and Monitoring Data review and strategies/tactics for improvement

Laboratory Stewardship – 4 Basic Elements Governance Leadership commitment Accountability to a high level medical executive Committee/subcommittees Laboratory expertise and other key support Networking

Laboratory Stewardship – 4 Basic Elements Interventions

Laboratory Stewardship – 4 Basic Elements Data Extraction and Monitoring Appropriateness of laboratory test orders. Retrieval of test results. Appropriateness of test interpretation. Impact of each stewardship intervention

Laboratory Stewardship – 4 Basic Elements Data review and strategies/tactics for improvement “An effective laboratory stewardship program will need to establish how the leadership committee will solicit and vet opportunities” “the committee may want to consider opportunities identified through the Choosing Wisely programs and other published research, or from internal data related to patient safety incidents”. Data review and strategies/tactics for improvement “An effective laboratory stewardship program will need to establish how the leadership committee will solicit and vet opportunities” “the committee may want to consider opportunities identified through the Choosing Wisely programs and other published research, or from internal data related to patient safety incidents”.

National Committee for Laboratory Stewardship Conclusion Evidence-based, patient-centered efforts to improve test utilization are justified, beyond being cost-effective, because they increase patient safety and Satisfaction NCLS has defined the core elements of a successful hospital-based laboratory Stewardship program NCLS future direction devise a tiered recognition program and provide certificates of recognition, depending on the degree of participation Conclusion Evidence-based, patient-centered efforts to improve test utilization are justified, beyond being cost-effective, because they increase patient safety and Satisfaction NCLS has defined the core elements of a successful hospital-based laboratory Stewardship program NCLS future direction -devise a tiered recognition program and provide certificates of recognition, depending on the degree of participation -promote a culture of quality and continuous improvement

Clinical Laboratory Stewardship Guidelines by the National Committee for Laboratory Stewardship