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

2. NCLS Publication

3. 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

4. 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

5. 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

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

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

8. Laboratory Stewardship – 4 Basic Elements
Interventions

9. 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

10. 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”.

11. 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

12. Clinical Laboratory Stewardship
Guidelines by the
National Committee for Laboratory Stewardship