Laboratory medicine

Using clinical guidelines to assess the potential value of laboratory medicine in clinical decision-making (2021)

Posted on by

Type of publication:
Journal article

Author(s):
Hicks A.J.; Carwardine Z.L.; *Hallworth M.J.; Kilpatrick E.S.

Citation:
Biochemia Medica; Feb 2021; vol. 31 (no. 1); p. 10703

Abstract:
Introduction: It is often quoted that 70% of clinical decisions are based on laboratory results, but the evidence to substantiate this claim is lacking. Since clinical guidelines aim to document best-practice decision making for specific disease conditions, inclusion of any laboratory test means that the best available evidence is recommending clinicians use it. Cardiovascular disease (CVD) is the world's most common cause of mortality, so this study reviewed all CVD guidelines published by five national/international authorities to determine what proportion of them recommended laboratory testing. Material(s) and Method(s): Five leading CVD guidelines were examined, namely the European Society of Cardiology (ESC), the UK National Institute for Health and Clinical Excellence (NICE), the American College of Cardiology (ACC), the Australian Heart Foundation (AHF) and the Cardiac Society of Australia and New Zealand (CSANZ). Result(s): A total of 101 guidelines were reviewed. Of the 33 individual ESC guidelines relating to CVD, 24/33 made a direct reference to the use of clinical laboratory tests in either diagnosis or follow-up treatment. The same applied to 15/20 of NICE guidelines, 24/32 from the ACC and 15/16 from the AHF/CSANZ. Renal function and blood count testing were the most recommended (39 and 26 times), with lipid, troponin and natriuretic peptide measurement advocated 25, 19 and 19 times respectively. Conclusion(s): This study has shown that laboratory testing is advocated by between 73% and 94% of individual CVD guideline recommendations from five national/international authorities. This provides an index to assess the potential value of laboratory medicine to healthcare.

Link to full-text [open access - no password required]

Current evidence and future perspectives on the effective practice of patientcentered Laboratory Medicine [Italian] Attualita e prospettive sull'efficacia pratica della Medicina di Laboratorio orientata al paziente (2016)

Posted on by

Type of publication:
Journal article

Author(s):
*Hallworth M.J., Epner P.L., Ebert C., Fantz C.R., Faye S.A., Higgins T.N., Kilpatrick E.S., Li W., Rana S.V., Vanstapel F.

Citation:
Biochimica Clinica, 2016, vol./is. 40/2(143-153)

Abstract:
Systematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally. This review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care. To maximize the value of laboratory medicine, work is required in 5 areas: a) improved utilization of existing and new tests; b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

Enhance It - Enhancing Hospital Laboratory Standards for Continuing Professional Development: Transnational Evaluation of a Novel CPD Activity for Specialists in Laboratory Medicine (2014)

Posted on by

Type of publication:
Conference abstract

Author(s):
Martin J, Gasljevic V, Sálek T, Horvath A, Borg C, Flegar-Meštrić Z, Jakovcic M, Silhavik J, Adonics A, Szlamka Z, Brincat I, Buttigieg D, Ciantar N, Sciortino AL, Mifsud A, Adkins A, *Bennett T, Rice K, Taylor Y.

Citation:
The Future of education 2014

Abstract:
A project which has received funding of over 100,000 euros from the European Union’s Lifelong Learning Leonardo Program is developing good practice in continuing professional development (CPD) for Specialists in Laboratory Medicine. The Partnership is developing an EU-toolkit for delivery of high quality CPD activities provided by European hospital laboratories. This paper reports on the first stage of the project which is transnational evaluation of a novel European CPD activity by hospital laboratories in Croatia, Czech Republic, Malta and the United Kingdom. An innovative CPD activity was designed to facilitate participation by Specialists in Laboratory Medicine in all partner countries. The topic of Health and Safety was chosen to enable maximum European participation as it is a multi-disciplinary topic of relevance to all Specialists in Laboratory Medicine in all partner countries. A series of thirty images of either good or bad laboratory practice in Health and Safety were provided to participants who were required to state whether the photograph depicted good or bad practise. If bad practise was shown Specialists in Laboratory Medicine were asked to explain what further actions would be taken including reporting procedures. On completion of the exercise, participants took part in a discussion group, completed a reflective learning sheet and filled in an evaluation questionnaire. Subsequently, in order to contextualise the CPD activity within their own laboratories participants will be asked to note any poor practice in their laboratory, discuss with colleagues, develop an action plan, repeat at monthly intervals and report on Health and Safety improvements. Over one hundred Specialists in Laboratory Medicine from four different European countries Croatia (n=14), Czech Republic (n= 10), Malta (n=65) and UK (n=29) took part in this new CPD activity. Several different grades of laboratory staff evaluated the activity and indicated that the exercise had been useful and appropriate to their scope of practice (99.2%) and relevant for their own CPD (97%). For over 80% of participants, this was the first time that they had taken part in this novel format of CPD activity. Discussion with colleagues following completion of the activity provided useful enhancement to both scope of practice (92%) and CPD (87%). Subsequent completion of a reflective learning sheet was shown to be beneficial for 86% of participants. We conclude that participation in this novel CPD activity which demonstrated a 100% overall satisfaction rate, has facilitated enhanced European cooperation between participating hospital laboratories and will provide a platform for future more intensive European co-operation by Specialists in Laboratory Medicine to work closely together to harmonise their practice and profession throughout the European Union.

Link to more details or full-text: http://conference.pixel-online.net/FOE/acceptedabstracts_scheda.php?id_abs=554#null

 

Current evidence and future perspectives on the effective practice of patient-centered laboratory medicine (2015)

Posted on by

Type of publication:
Journal article

Author(s):
*Hallworth M.J., Epner P.L., Ebert C., Fantz C.R., Faye S.A., Higgins T.N., Kilpatrick E.S., Li W., Rana S.V., Vanstapel F.

Citation:
Clinical Chemistry, April 2015, vol./is. 61/4(589-599), 0009-9147;1530-8561 (01 Apr 2015)

Abstract:
BACKGROUND: Systematic evidence of the contribution made by laboratory medicine to patient outcomes and the overall process of healthcare is difficult to find. An understanding of the value of laboratory medicine, how it can be determined, and the various factors that influence it is vital to ensuring that the service is provided and used optimally. CONTENT: This review summarizes existing evidence supporting the impact of laboratory medicine in healthcare and indicates the gaps in our understanding. It also identifies deficiencies in current utilization, suggests potential solutions, and offers a vision of a future in which laboratory medicine is used optimally to support patient care. SUMMARY: To maximize the value of laboratory medicine, work is required in 5 areas: (a) improved utilization of existing and new tests; (b) definition of new roles for laboratory professionals that are focused on optimizing patient outcomes by adding value at all points of the diagnostic brain-to-brain cycle; (c) development of standardized protocols for prospective patient-centered studies of biomarker clinical effectiveness or extraanalytical process effectiveness; (d) benchmarking of existing and new tests in specified situations with commonly accepted measures of effectiveness; (e) agreed definition and validation of effectiveness measures and use of checklists for articles submitted for publication. Progress in these areas is essential if we are to demonstrate and enhance the value of laboratory medicine and prevent valuable information being lost in meaningless data. This requires effective collaboration with clinicians, and a determination to accept patient outcome and patient experience as the primary measure of laboratory effectiveness.

Comparison of approaches and measurement of continuing professional development for specialists in laboratory medicine within four European countries (2014)

Posted on by

Type of publication:
Journal article

Author(s):
Martin J, Gasljevic V, Sálek T, Horvath A, Borg C, Flegar-Meštrić Z, Jakovcic M, Silhavik J, Adonics A, Szlamka Z, Brincat I, Buttigieg D, Ciantar N, Sciortino AL, Mifsud A, Adkins A, *Bennett T, Rice K, Taylor Y.

Citation:
Clin Chem Lab Med. 2015 Jan 1;53(1):35-44

Abstract:
Abstract Background: This study investigated approaches to continuing professional development (CPD) for specialists in laboratory medicine within four European countries: Croatia, the Czech Republic, Malta and the UK.

METHODS:

The research questions focussed on ascertaining if continued registration/licence was linked to CPD and if so, were there requirements for certain amounts and types of CPD and for CPD activities to meet specified accreditation criteria. The Professional Associations Research Network (PARN) model of CPD measurement was applied to each country’s registration/licencing body’s CPD requirements.

RESULTS:

Our results indicate a spectrum of approaches to CPD within participating countries.

CONCLUSIONS:

It will be necessary for European employers to be familiar with these differences and to take them into account for this increasingly mobile European workforce.

Link to more details or full-text: http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=25060347&athens.asp&site=ehost-live

Demonstrating the impact of laboratory medicine on clinical outcomes (2014)

Posted on by

Type of publication:
Conference abstract

Author(s):
*Hallworth M.

Citation:
Clinical Chemistry and Laboratory Medicine, July 2014, vol./is. 52/(S34), 1434-6621 (July 2014)

Abstract:
Clinical laboratory workers believe that the work they perform in providing laboratory tests is valuable. However, data to validate this has been limited, and evidence of the contribution of laboratory medicine to the overall process of diagnosis and management is not easy to obtain. This session will describe the work of the IFCC Task Force on the Impact of Laboratory Medicine on Clinical Management and Outcomes (TF-ICO). It will examine existing evidence, review the gaps in our understanding and deficiencies in the way laboratory medicine is used, and indicate how these can be remedied. Many articles and presentations seeking to promote the value of laboratory medicine have made use of what has become known as the ”70% claim”. This is presented in various forms, most commonly that ”Laboratory Medicine influences 70% of clinical decisions”, or minor variations around this figure. However, the data on which this estimate was based represents unpublished studies and anecdotal observations, and cannot now be objectively verified. The IFCC TF-ICO was established in 2012 to evaluate the available evidence supporting the impact of laboratory medicine in healthcare, and to develop the study design for new studies to generate evidence of the contribution made by laboratory medicine. This presentation will examine existing evidence, review the gaps in our understanding and deficiencies in the way laboratory medicine is currently used, indicate how these might be remedied and offer a vision of a future state in which laboratory medicine is used effectively to support patient care and enhance patient safety. An approach to measuring value will be proposed in which the net value of a testing process is defined as delivered benefits minus delivered harm (undesirable effects of testing). Value is maximized by increasing the benefits and reducing harm. Much of the evidence relating to the value of laboratory medicine is poorly structured and does not relate to clinical outcomes. A more rigorous approach is required. Laboratory medicine has much to offer, but can cause adverse outcomes if not properly used. Laboratorians need to refocus their attention onto improving outcomes.

Link to more details or full-text: