The Centers for Disease Control and Prevention (CDC) and Battelle Memorial Institute (Battelle) are pilot-testing methods for conducting evidence based evaluations of best practices in laboratory medicine. Exploratory work suggests that although published evidence of practice effectiveness is limited in the laboratory medicine field, this information may be in the form of internal assessments produced for quality improvement, organizational decision making or monitoring purposes.
CDC is interested in information that demonstrates the impact of a practice implemented as compared to standard practice and are seeking healthcare organizations willing to share unpublished quality improvement studies or other in house assessments.
Pilot Reviews were completed in 2008 for selected practices in the following topics areas:
- Patient specimen identification
- Critical values test result communication
2009 Evidence Reviews
For the pilot test currently underway, systematic evidence reviews of the effectiveness of practices will be considered as specified below for 3 topic areas.
The first two topics (patient specimen identification and critical values communication) are limited to the practices specified, while the specific practices for blood culture contamination are under review, however some examples are provided.
| Patient Specimen Identification Practices (to reduce identification errors) |
Description |
Outcome Measures of Practice Effectiveness |
| Bar Coding Systems |
Electronic bar coding on both patient and specimen used to establish positive identification of specimen belonging to patients. This involves the use of scanners and capability to print labels |
- Identification errors/error rate
- Incorrect specimen containers
- Number of correctly labeled samples
- Specimen rejection rate
- Unnecessary phlebotomies
|
| POCT Bar Coding Systems |
Automated patient and sample identification system using bar-coded patient armbands and bar code scanners when diagnostic testing is conducted at or close to the patient |
- In-patient specimen identification error rate
- Percent in-patient identification error rate for specific (POC) test ( e.g. glucometry)
- Number of correctly labeled samples
|
| Critical values test results communication (to improve timeliness and accuracy of reporting) |
Description |
Outcome Measures of Practice Effectiveness |
| Automated Notification |
Automated alerting system or computerized reminders using mobile phones, pagers, email or other personal electronic devices to alert clinician of critical laboratory results. |
- Time interval from dispatching critical value result alert to acknowledgement by responsible caregiver
- Time interval from filing of the alerting result and ordering appropriate treatment
- Time interval between filing of the alerting result and the resolution of the critical condition
- Clinical response time to critical values alerting
- Frequency of adverse events
- Length of stay
- Patient satisfaction and safety
|
Practices to reduce Blood Culture Contamination
Examples are:
|
Outcome Measures of Practice Effectiveness |
| Dedicated phlebotomy |
Blood culture contamination rates |
| Collection site (venipuncture vs. IV catheter) |
| Skin antiseptic agents |
| Collection technique ( 1 vs. 2 needle) |
How can your organization participate?
To volunteer your organization to participate in the LMBP Pilot Network, or if you have specific questions about the project, contact:
Battelle Memorial Institute
Edward B. Liebow
206-528-3155
Frequently Asked Questions:
What information should be submitted?
The Laboratory Medicine Best Practices initiative is seeking submissions of unpublished quality improvement studies or other in-house assessments from individual hospitals, clinics or other institutions. Currently, an approach for obtaining this information is under development that relies on a template that identifies what information to provide for each practice evaluated along with guidance on how to provide it.
- At a minimum, there should be at least one quantitative finding or measured impact for each practice.
- No "new" data collection is requested from participating laboratories; similar to using published studies as evidence, the pilot test will also rely on unpublished, previously completed data collection and evaluation efforts that provide information about the effectiveness of specific practices.
- No patient-specific data or personal health information is requested.
- Individual laboratories, hospitals, hospital systems, clinics, or other institutions have the option to be identified as participants or remain anonymous in publications or summaries describing the pilot test and its findings.
How Does the Pilot Test work?
- Health care organizations and laboratories with previously completed unpublished studies or assessments in topic areas and practices listed above are invited to participate in the current methods pilot test.
- Battelle and CDC will assemble Expert Panels with appropriate training and experience in evidence evaluation and laboratory medicine and operations for each topic. The Expert Panels will define specific research questions, parameters and criteria for practices to be evaluated in each topic area.
- CDC and Battelle scientists supporting the Expert Panels and pilot study Laboratory Medicine Best Practices Network participants, will identify, screen, organize, abstract, and evaluate evidence—published and unpublished—concerning the effectiveness of the candidate practices.
- The Expert Panels will review the entire body of evidence for each practice, and draft a systematic evidence review with a summary evaluation of the strength of evidence and effect size to support an evidence-based recommendation.
- For the purposes of the pilot test, the Laboratory Medicine Best Practices Workgroup will act as a "Recommending Body." The Workgroup will review the draft evidence review, summary statements and supporting documentation provided by the Expert Panels to decide on recommendations concerning each practice (i.e., recommend, no recommendation for or against, recommend against).
What are the Costs of Participating?
The primary costs to organizations participating in the pilot test will be the time of the staff involved (e.g., laboratory director, quality improvement manager) designated as the primary study contact, and the time of other personnel in identifying, and submitting unpublished studies. No other significant costs are anticipated.
What are the Benefits of Participation?
Your facility will benefit from the exchange of information about best practices in laboratories and supporting information related to the implementation and the use of these practices. This will contribute to your facility's quality improvement efforts, support purchase of new technology, and improve laboratory processes and organization. Participation in the Laboratory Medicine Best Practices pilot test by submitting unpublished studies has been endorsed by major laboratory accrediting and professional organizations including The Joint Commission, College of American Pathologists (CAP), COLA, Clinical Laboratory Management Association (CLMA), American Society of Clinical Pathology (ASCP), and National Association of Clinical Biochemistry (NACB).
What are Laboratory Medicine Best Practice Network Participants asked to do?
- Designate a primary contact (e.g., senior laboratory scientist, laboratory director, or other appropriate staff) for following up on information submitted
- Identify and manage requirements necessary to provide requested information, potentially including an Institutional Review Board process
- Submit requested specific, de-identified information based on instructions to be provided (currently under development). Please contact Edward B. Liebow at Battelle Memorial Institute for more information.