Nation’s healthcare system is in the midst of major clinical, organizational, and financial reforms—many of which require immediate responses by pathology laboratories
BIRMINGHAM, England—Two major challenges in laboratory medicine were front and center this week when medical laboratory, a professionals and histopathologists gathered here in the United Kingdom (UK) for the eleventh annual Frontiers in Laboratory Medicine (FiLM).
One challenge is how to improve the quality of lab testing services and demonstrate value to payers. The other challenge is how medical laboratories in the UK can cope with shrinking budgets for medical laboratories.
Clinical Laboratories in Most Countries Face Same Challenges
Neither challenge is unique to the UK! Regular readers of Dark Daily know that medical laboratories in every developed nation are caught in a vice that is not of their own making. One jaw of this vice is the funding cutbacks being pushed onto clinical and histopathology labs by their respective health systems. The other jaw of this vice is the unwillingness of health program administrators to recognize the high value that medical laboratory testing delivers to physicians, patients, the health system itself.
That is why on FiLM’s opening day, the first keynote session dealt with the findings of the just-published Pathology Quality Assurance Review. (For Dark Daily readers outside the UK, the term pathology laboratory is used to describe a medical/clinical laboratory and the term histopathology describes anatomic pathology/surgical pathology.) Thus, the Pathology Quality Assurance Review was an assessment of the medical laboratories in the nation.
Medical Direct Requested Review of UK Pathology
This review was conducted at the request of Professor Sir Bruce Keogh, the Medical Director of the UK’s National Health Service (NHS). The request was made following public disclosure that patients at one NHS trust were negatively impacted due to systemic problems within that organization’s delivery of healthcare. Co-presenters of this important presentation were Dr. Ian Barnes, who was Chair of the review, and Peter Huntley, who served as Workstream Lead for the review.
Barnes and Huntley described the case for changing quality assurance in pathology as follows:
- Pathology quality assurance (QA) is mainly focused on analytical phase, and until recently, there has been little performance assessment of the quality of pre- and post-analytical phases.
- Pathology laboratory accreditation focused on internal processes, but not on the quality of the results and information produced.
- Currently there is a lack of measures for clinical effectiveness of pathology testing.
- Transition to ISO 15189 accreditation within the United Kingdom will require increased focus on the whole of the end-to-end assessment of a pathology laboratory and its clinical effectiveness.
In the formal report produced by the Pathology Quality Assurance Review panel that was published this week, there were recommendations that covered a wide span of activities. Among the recommendations were:
- Better training of pathology professions in quality management,
- More collaboration with commissioners that includes appropriate benchmarks (key assessment indicators (KPIs) for pathology organizations within the commissioning process,
- Creation of the framework for an external quality assurance structure focused on both the pathology lab organization and its individual staff members, and
- Development of a structure for error reporting, along with creating a system to share learning and best practices across laboratories within the United Kingdom.
Demonstrating the Value of Pathology Testing
FiLM presented several speakers to discuss the challenge of demonstrating the value of pathology testing to physicians, patients, and health system administrators who pay the bills. Each had examples of innovative and clever medical laboratory testing services that their medical labs are using to increase the value of lab testing services.
From the Northern Devon Healthcare NHS Trust, Tom Lewis, a Consultant Medical Microbiologist, discussed how he left his laboratory specifically to visit nearby general practice clinics and help those physicians better use lab tests to improve patient outcomes. His co-presenter was Darunee Whiting, M.D., a General Practice physician and Clinical Lead for Diagnostics Commissioning at Devon Northern Locality Commissioning Board.
In close interaction with the clinical team, Lewis and Whiting worked to provide more precision in the process of how certain urine tests were ordered, collected, and acted upon. As a result of this proactive consulting with the pathology lab team, the 22 medical practices in North Devon achieved a 40% reduction in urine specimens, while saving the parent organization more than £200,000 (US$330,000) per year. Another important benefit was reduced potential for iatrogenic harm to patients.
Medical Laboratory Professionals Need to Do More
In response to sessions like these, attendees at FiLM acknowledged that the entire laboratory medicine profession must do more to meet the challenges of declining budgets for lab testing and need to continuously improve the quality of lab testing services. In particular, there was broad concurrence that sending lab scientists out from the core lab and into the wider clinical community would pay rich dividends in reduced healthcare spending and improved patient outcomes. But the inadequate staffing at most medical laboratory organizations makes it difficult for lab scientists with the most sophisticated training and experience to free up the time to get visit clinics and other healthcare settings to work one-on-one with clinicians.
Anyone who wants to learn more about the annual Frontiers in Laboratory Medicine conference can visit the website at: www.frontiersinlabmedicine.com. The meeting is co-produced annually by the UK’s Association for Clinical Biochemistry and Laboratory Medicine and The Dark Report of the United States.
Denmark Will Consolidate Hospitals and Their Medical Laboratories
Finally, there is one development discussed at FiLM that will be of interest to many Dark Daily readers worldwide. Denmark is the latest developed nation to embark on a nationwide regionalization and consolidation of hospital services. In his presentation, Per E. Jørgensen, M.D., DMSc, Medical Director at Glostrup University Hospital in Denmark, explained that the national health system is planning to concentrate hospital services into just 20 hospitals, down from the 46 hospitals currently operating in that country.
This will provide a larger volume of specimens at these hospital laboratories and enable them to offer a more sophisticated menu of medical laboratory tests and expertise. One aspect of this national initiative is to encourage further standardization of lab test menus and lab test methodologies within Denmark.
Your Dark Daily editor,
Robert L. Michel