Laboratory Stewardship Focus: Quarterly Section in Clinical Laboratory News

PLUGS® is supporting CLN’s new Laboratory Stewardship Focus section!

The editors of Laboratory Steward­ship Focus welcome you to this experi­ment in stewardship education. We are a diverse group of editors consisting of a clinical chemist, an informaticist, two pathologists, and a genetic counselor. Our goal is to cover all aspects of laboratory stewardship using a variety of engaging formats including interviews, articles, literature reviews, cases, and more.

Read more about why PLUGS is supporting CLN’s Laboratory Stewardship Focus.

Latest Articles

Ethics of Al and Big Data in Laboratory Medicine
Date: JAN.1.2020
Author: Brian Jackson, MD, MS

Today a new technology is changing the world in even more dramatic and far-reaching ways: artificial intelligence (AI). It has revolutionized advertising, entertainment, and education, and is invading many other areas of our lives. Some of the most obvious examples include self-driving cars, phones that understand our speech, and online search engines that answer virtually any question. Less obvious examples operate behind the scenes in retailing and service industries. And the medical world has high expectations for AI to improve healthcare.

How to Say No to Sendouts
Strategies for coping with tests that aren’t ready for clinical use
Date: OCT.1.2019
Author: Michael Astion, MD, PhD

Bill Malone, managing editor of Clinical Laboratory News, interviewed Mike Astion, MD, PhD, medical director of the laboratories at Seattle Children’s Hospital, about how to approach these kinds of tests. Astion is a co-founder of the Patient Centered Laboratory Utilization Guidance Service (PLUGS), a member-based network of more than 100 hospitals and commercial labs whose mission is to improve test utilization.

The 3 C’s of Improving Lab Stewardship: Collaboration, Champions, CPOE
An illustrative story of improving testing for C3 glomerulonephropathy
Date: OCT.1.2019
Author: Jane Dickerson, PhD

Impact and ease of implementation are two general ways to categorize laboratory stewardship interventions (1). For example, sending an email about best practice guidelines is easy to do but most likely will have little impact on actual practice. Conversely, building rules in an electronic health record to alert when best practice guidelines are not being followed is more difficult to implement but has a higher impact on actual practice. A recent meta-analysis by Rubenstein and colleagues reviewed the effectiveness of various laboratory stewardship interventions, and found that those with the highest evidence ratings involved computerized-provider order entry (CPOE) systems and combined interventions (2). But, as discussed in a recent lighthearted editorial in Clinical Laboratory News, knowing what to do and actually doing it are different things that involve different skills (3). What follows is a practical story of both knowing and doing. While the story highlights a specific esoteric test, the approach this case describes would apply broadly to any stewardship challenge.

Blurred Lines
Comparing Direct-to-Consumer and Clinical Testing
Jacquelyn Riley, MS, LGC, and Katie Stoll, MS, CGC

As the direct-to-consumer (DTC) sector of the laboratory industry has exploded, advocates have asserted that these tests remove potential barriers in our traditional healthcare system and increase access to important health information while boosting both convenience and privacy.

Overdiagnosis: An Unintended Side Effect of Diagnostic Testing
An interview with: H. Gilbert Welch, MD, MPH
Jane Dickerson, PhD, and Brian Jackson, MD

Jane Dickerson, PhD, and Brian Jackson, MD, of CLN Laboratory Stewardship Focus recently interviewed physician and author, H. Gilbert Welch, MD, MPH, about the problem of overdiagnosing patients. A general internist who for the past 2 decades has studied the problem of overdiagnosis, Welch is nationally recognized for his many journal articles and books on the topic, including Overdiagnosed: Making People Sick in the Pursuit of Health (1) and most recently, Less Medicine, More Health: 7 Assumptions that Drive Too Much Medical Care (2).

Perimortem Genetic Testing in a Children’s Hospital
A Team Approach to Policy Development
Date: APR.1.2019
Author: Darci L. Sternen, MS, LCGC, and Bonnie Cole, MD

Genetic testing in the perimortem period—immediately before or after a patient’s death—involves unique ethical and logistical issues in pediatric hospitals. Genetic testing may be necessary to confirm an underlying diagnosis, yet testing may not be medically necessary because the results will not change medical care for the child.

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The Importance of Genetics Experts in Optimizing Genetic Test Orders Through Prospective and Retrospective Reviews.

Authors: M Edye Conway, Cassidi Dailey Kalejta, Darci L Sternen, and Ila R Singh.

PLUGS (Patient-centered Laboratory Utilization Guidance Services) along with our partner Metis Genetics and Texas Children’s Hospital, undertook a study to demonstrate the potential impact of genetics specialists on identifying genetic test order errors, improving health insurance reimbursement for genetic testing, and providing cost savings. This study was conducted to help uncover the benefits of a laboratory stewardship or utilization management program led by genetic counselors.

Read the full article here.


Laboratory Stewardship for Clinical Genetic Testing

Author: Jessie Conta

Ensuring appropriate utilization of genetic tests and reducing errors improves patient care, reduces costs, and lays an important foundation of trust between patients, providers, institutions, and insurers. Rapid evolution of assays, expansion of genetic tests into multiple medical specialties, direct consumer access, and focus on precision-medicine initiatives foretell a future where genetic test stewardship programs are essential to supporting quality patient care. This review article summarizes the impact of genetic counselors and targeted stewardship interventions that improve genetic test utilization.

Read the full article here.


Clinical and Histopathologic Predictors of Disaccharidase Deficiency in Duodenal Biopsy Specimens

Authors: Robyn Reed and Cristina Pacheco

Disaccharidase (DS) activity in duodenal biopsy specimens is the gold standard for diagnosing DS deficiency. We investigated strategies to reduce the need for DS testing and whether clinical or histopathologic factors predict DS deficiency.

Read the full article here.


Precision Medicine Podcast: a Laboratory Stewardship Program to Foster Precision Medicine Best Practices

PLUGS’ Dr. Michael Astion was a featured guest on The Precision Medicine Podcast! Listen to the full podcast here.

Laboratories could be considered the epicenter of the precision medicine industry, so we were thrilled to have Dr. Michael Astion, Medical Director for the Department of Laboratories at Seattle Children’s Hospital join us. In this episode, he introduces us to PLUGS, (Patient Centered Laboratory Utilization Guidance Service) a grassroots program he co-founded that exists to promote and strengthen laboratory stewardship.