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Clinical Laboratories and Pathology Groups
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Clinical Laboratories and Pathology Groups
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Collaboration between Pathologists, Medical Laboratories, and Hospital Staff Substantially Reduced Hospital-Acquired Infections, AHRQ Reports

Jul 26, 2017 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology

Decline in hospital-acquired conditions (HACs) overall since 2010 attributed to increased attention to safety protocols and practices by hospital staff in cooperation with clinical laboratory services

It’s now been almost nine years since the Medicare Program stopped paying hospitals and other providers for certain hospital-acquired conditions (HACs). Included in this list are hospital-acquired infections (HAIs). The goal is to substantially reduce the number of HACs and HAIs, thus improving patient outcomes, while substantially reducing the healthcare costs associated with these conditions.

So, almost nine years into these programs, has there been progress on these goals? This is a question of key interest to Medical laboratories and pathology groups because they have a front-line role in working with clinicians to diagnose and treat HAIs, while also looking to identify the transmission of HAIs within the hospital.

A recent report by the Agency for Healthcare Research and Quality (AHRQ), a division of the US Department of Health and Human Service (HHS), indicates that there has been progress in the goal of reducing HACs. The AHRQ report noted a 21% decline in HACs between 2010 and 2015. Data collected during that time indicates a reduction of more than 3.1 million HACs and nearly 125,000 patient deaths due to HACs.

In 2015 alone, nearly one million fewer HAC incidents occurred. The reduction saved “approximately $28 billion in healthcare costs,” an outcome which, the AHRQ report notes, is the result of increased attention to safety protocols in hospitals and a “period of concerted effort by hospitals throughout the country to reduce adverse events.”

Clinical Pathologists/Laboratories Play Key Role in HAI Prevention

Though many reported incidents are associated with adverse drug events, HAIs have been significantly reduced in recent years due to focused efforts on infection prevention. The report notes that clinical pathologists have become vital players in infection prevention programs, and that increased coordination between hospital medical laboratories and clinicians played a crucial role in the reduction.

Eileen O’Rourke is an Infection Preventionist at the Lankenau Medical Center in Philadelphia. And she has served as a leader and consultant for hospital-based infection prevention programs in Pennsylvania since 1984. In an article on the Wolters Kluwer Pharmacy OneSource blog, O’Rourke noted that successful infection prevention and control requires development of “a highly visible and administratively supported infection prevention and control program with qualified and trained personnel.” Clinical pathologists are part of that support team, providing surveillance, testing, and interpretation of data essential for identifying epidemiological origins of infection and pathogen distribution. And the vital services that clinical laboratories provide to reduce HAIs center on surveillance, prevention, and control.

The chart above was calculated on US Dollars in 2012. Since then, thanks to contributions by medical laboratories and pathologists in collaboration with hospitals, those costs have decreased significantly. (Image copyright: MLive.com.)

In an article for Lab Testing Matters, John Daly MD, Chief Medical Officer at the Commission on Office Laboratory Accreditation, and former Director of Clinical Laboratories for the Duke University Health System, highlights the importance of surveillance. He states that it is “an essential element of an infection control program” providing “data to identify infected patients and determine the site of infection” as well as “factors that contributed to the infection.” Medical laboratories must, Daly stresses, provide “easy access to high-quality and timely data and give guidance and support on how to use its resources for epidemiologic purposes.”

Daly argues that medical laboratories function as liaisons to clinical services, working to “improve the quality of specimens sent to the laboratory and promoting appropriate use of cultures and other laboratory tests.” The laboratory should, according to Daly, be involved in all aspects of the infection control programs. This ensures:

  • Proper specimen collection;
  • Accurate and rapid testing; and
  • Accurate reporting of laboratory data.

Laboratory Data Provide ‘Early Warning’ for HAI Surveillance Systems

Robert A. Weinstein, MD, wrote in his 1978 article, “The Role of the Microbiology Laboratory in Surveillance and Control of Nosocomial Infections,” that medical laboratories and pathologists are central to prevention and control of HAIs. Laboratory records, Weinstein remarked, serve as important data sources that can identify early spread of infection, thus becoming an “early warning system” for a potential outbreak of infections. The sampling that laboratories perform identifies not only the strain of infection, but the method by which infection is spread, and the best treatment options. Nearly 40 years later his statements ring truer than ever, as anatomic pathology laboratory data continues to reveal patterns of infection faster and more precisely than ever before.

Sarah Mahoney, PhD, is a research scientist at Navitor Pharmaceuticals in Cambridge, Mass. In an article published in the American Journal of Clinical Pathology, she states that in surveilling patterns of infection, pathologists also decipher the source of infection. Mahoney wrote that it is “necessary to identify the causative organism” for surveillance and management control of HAIs. She also noted that pathologists must strive to discriminate between “hospital- and community-acquired infection” in order to provide clinicians with guidance for treatment, and to map “infection transmission within a clinical setting.”

Hospitals Rely on Medical Laboratories and Pathologists to Help Reduce HAIs 

The concerted effort to reduce HACs and HAIs was inspired by incentives put forth by the US government. In 2008-2009, the Centers for Medicare and Medicaid Services (CMS) ceased paying for hospital-acquired conditions, including HAIs. Since that time, hospitals have worked to prevent and better manage HAIs. In the years since those incentives went into effect, hospitals have increasingly relied on medical laboratories and pathologists to provide necessary testing to prevent HAIs.

The CDC’s Antimicrobial Stewardship Programs create a further need for lab professionals to be involved in the identification, prevention, and treatment of HAIs. The core elements of the program state that the role of diagnostic laboratory testing—especially rapid diagnostic tests—is imperative in providing the necessary data needed to combat HAIs. The pressure is on for hospitals to reduce HAIs further to save lives and reduce costs. Thus, there is increased pressure on medical laboratories as well.

In an article in the College of American Pathologists’ online journal Cap Today,

Larry Massie, MD, Professor of Pathology at the University of New Mexico, and Chair of Pathology and Laboratory Medicine for the New Mexico VA Health Care System in Albuquerque, states that turn-around time is crucial for HAIs, but that laboratories often have difficulty keeping up with large volumes of samples. Massie suggests the use of new technologies could speed up turnaround time, particular for large healthcare providers.

The fight to reduce HAIs and HACs is showing significant progress, and clinical laboratories, working in tandem with clinicians and prevention programs, are a fundamental part of the success of HAI reduction. Clinical pathologists and laboratories often are the front line in prevention and management of HAIs, and the work they do in identifying infections is essential in the assessment and control of those infections.

— Amanda Warren

  

Related Information:

National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data from National Efforts to Make Health Care Safer

How Hospitals Can Reduce Hospital-Acquired Infections

HAI Data and Statistics

Hospital Acquired Infection: Molecular Study and Infection Control Guidelines

Rapid Sequencing and Characterization of Pathogens in Hospital-Acquired Infections

The Role of the Microbiology Laboratory in Surveillance and Control of Nosocomial Infections

Core Elements of Hospital Antibiotic Stewardship Program

Pressure’s on to Halt Nosocomial Infections

Hospital Acquired Infections

Surveillance of Hospital-acquired Infections: A Model for Settings with Resource Constraints

The Laboratory and Infection Control

Role of the Microbiologist in Infection Control and Hospital Epidemiology

Study Finds Occupying Hospital Bed Previously Used by Patient Receiving Antibiotics Increases Odds of Developing C.diff Infection

Even as Patient Satisfaction Surveys Grow in Importance, Hospitals, Physicians, and Clinical Laboratories Struggle to Use That Data to Improve the Patient Experience

Feb 24, 2017 | Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Laboratory Testing

Experts point to the challenges: not only is there a lack of consensus in how to best measure patient satisfaction, but there are also different opinions as to what are the right steps providers should take to improve the patient experience

In today’s healthcare industry, “Patient Satisfaction” is high on the list of phrases likely to be heard in any medical facility, including in pathology groups and clinical laboratories. With recent and ongoing changes to the way that providers are paid, patient satisfaction as a measure of quality will only gain in importance.

But if there is consensus that it is important to monitor patient satisfaction and use that data to guide efforts to improve how patients view their care, there is certainly no consensus on the most effective ways to measure patient satisfaction. Nor is there much consensus on how providers, including medical laboratories, should use patient satisfaction data to improve the patient experience.

This challenge is addressed by Deirdre Mylod, PhD, who pointed out in a PatientEngagementHIT article, “The exercise is not to make consumers happy. The exercise is to reduce patient suffering.” Mylod is Executive Director of the Institute for Innovation, a nonprofit research collaborative that publishes relevant and practical findings concerning patient satisfaction that help healthcare organizations deliver better care. (more…)

Research Study at Johns Hopkins University Reveals CDC Does Not Record Medical Errors in Annual Mortality Report, Yet Such Errors Are Third Leading Cause of Death

Jun 29, 2016 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology

An earlier Johns Hopkins study looked at diagnostic errors and determined that such errors were the leading cause of malpractice payouts. Can clinical laboratories help?

At a time of heightened transparency in healthcare outcomes, a Johns Hopkins University School of Medicine (Johns Hopkins) study makes a startling conclusion: medical errors are an under-recognized cause of patients’ deaths in the United States. In fact, medical errors rank third—after heart disease and cancer—in causing patients’ deaths, according to a Johns Hopkins statement.

This finding has many implications for pathologists and clinical laboratory managers. Often, medical errors are associated with the failure of physicians to order correct medical laboratory tests at critical junctures. Alternatively, a medical error can result if the physician fails to take appropriate action after getting an accurate lab test result. Thus, any effort within the health system to reduce medical errors will probably bring pathologists and medical laboratory scientists into closer consultation with clinicians.

What the researchers at Johns Hopkins also learned during their study is that medical error is not reported as a cause of death on death certificates. Further, the Centers for Disease Control and Prevention (CDC) has no “medical error” category in its annual report on deaths and mortality, The New York Times (NYT) reported. (more…)

Recent Study Estimates that 5% of Patients in Outpatient Settings Are Misdiagnosed, Offering Pathologists an Opportunity to Provide More Consultations to Doctors

Aug 11, 2014 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations

This spring, researchers at the VA Hospital in Houston published a study revealing that one in 20 patients in outpatient settings are misdiagnosed

Publication of new peer-reviewed clinical studies indicates that, within the United States, more than 5% of outpatients—or 12 million people—are misdiagnosed annually. Few pathologists and clinical laboratory scientists would dispute this number because every day they see the best and the worst of how physicians use medical laboratory tests.

These findings were reported in a study published in the April edition of the British Medical Journal, BMJ Quality & Safety. (more…)

Could Patient-Error Reports Cause Pathologists To Be Responsible for Other Providers’ Mistakes?

Dec 31, 2012 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology

Who is responsible when a patient is misdiagnosed because the patient’s physician read a clinical laboratory test report incorrectly?

Could clinical pathologists be held responsible for medical errors caused by other providers? That’s a possibility under a proposal from the federal Agency for Healthcare Research and Quality (AHRQ).

AHRQ is seeking approval for a prototype of a new reporting system for medical errors, AHRQ Director Carolyn M. Clancy, M.D., told The New York Times in a story published on September 22, 2012. “Currently there is no mechanism for consumers to report information about patient safety events,” she said.
(more…)

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