We know the positive impact that laboratory medicine has on healthcare, but is the general public aware? In fact, are those who actually work in the healthcare community even aware? The short answer in most cases is: no. Laboratory medicine is not very visible – I believe that those of us working in the field have not been as active as we need to be in taking responsibility for improving the total testing process, and getting out of the lab and talking to patients, clinicians and administrators. I believe that this needs to change. It’s so important that the value of what we do is recognized – not only so that we can promote better use of tests and patient care, but also for our own job satisfaction – and the only way that we can do that is to present the evidence. The task force on the impact of laboratory medicine on clinical management and outcomes was set up with that precise objective in mind. And there are two key methods of achieving this. First: we evaluate the available evidence supporting the impact of lab medicine on healthcare. Second: we develop new retrospective and prospective studies to support the promotion of the importance of laboratory medicine to the healthcare community and to the general public.
What drove scientists from across Europe, the US and Asia to come together in this task force? Quite simply, it’s the lack of hard data. Laboratory workers have traditionally been good at assessing the reliability of tests, but when it comes to assessing the outcomes of their work, studies have been neglected. And it might surprise you that the often-quoted statement, “70 percent of clinical decisions are based on laboratory tests” is, unfortunately, not supported by any studies published in the literature.
It is clear that any blanket figure will be misleading and dangerous. We have reviewed a lot of evidence on the impact of laboratory medicine interventions on clinical outcomes and cost-effectiveness – the resulting paper has been submitted for journal publication. However, we face two main obstacles to getting the evidence that we need to link testing with outcome. Firstly, to improve outcomes, a lab test must be appropriately ordered, properly conducted, returned with results on a timely basis, correctly interpreted and finally, of course, it must affect a decision for further diagnosis and treatment. Laboratory medicine workers have done a huge amount to improve the quality of results, but improving patient outcomes requires us to look at the whole of the testing process. Secondly, traditional evaluations of laboratory tests have focused on the performance of the tests in terms of diagnostic accuracy and predictive value for disease. We need more studies that are designed from the start to include patient outcome measures.
Our evidence review, in conjunction with the presentations that we deliver at congresses, will stress the need for laboratory professionals to be more involved in the total testing process (from initial request to interpretation and action) and for better evaluations of laboratory tests. Laboratory doctors and scientists need to help produce guidelines for investigation, advise clinical staff on the best test for individual clinical presentations and on further studies needed to confirm a diagnosis, ensuring that key results are not misinterpreted or missed, and that services are used appropriately. Getting that right means better use of tests, better patient care, lower healthcare costs, improved job satisfaction for laboratory workers and enhanced ability to recruit and retain good scientists. That’s a goal worth working for.
Mike Hallworth is chair of the IFCC task force on the impact of laboratory medicine on clinical management and outcomes, UK.
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