By Robert Maynard, PhD, NRCC
On Tuesday morning, a compelling session, titled “Laboratory test showdown! Winning with laboratory stewardship,” drew a packed audience eager to learn strategies for optimizing test utilization. Led by Allison Chambliss, PhD, DABCC, FADLM, and Jane Dickerson, PhD, DABCC, the session illuminated the critical role of laboratory stewardship in modern healthcare, offering practical insights on how to create successful laboratory stewardship programs to manage both in-house and send-out testing challenges.
Chambliss launched the session by discussing the essential elements of a successful laboratory stewardship program. She noted that a key challenge facing laboratories today is helping patients and providers navigate increased test availability. For example, new biomarkers are being commercialized either through diagnostic companies or reference labs. “Having a system where those requests can be approached systematically is very important,” Chambliss said.
She highlighted the PLUGS (Patient-centered Laboratory Utilization Guidance Services) guidelines as a reference for laying a strong foundation, drawing on experience from both speakers’ successful longstanding stewardship programs. Audience polling and participation was instrumental to the thriving discussion that took place throughout this presentation.
During her lightning talk, “Laboratory stewardship: Winning with systematic solutions,” Dickerson offered strategies for managing changes to routine, high-volume tests, including renaming laboratory tests, revising order sets, and monitoring ordering frequency with automated alerts. “Laboratory stewardship can be justified by the value it provides,” Dickerson explained.
She noted that a test’s value is a function of both its quality and its cost. She outlined two real-word examples to show the value of laboratory stewardship: a request for metagenomics next-generation sequencing for a transplant patient and a miscellaneous test order for endomysial antibody to evaluate a patient for celiac disease. Each case highlighted the importance of considering how tests results will be used in patient management decisions and whether these tests are the current standard of care.
In her presentation, “Laboratory Stewardship: Winning with Case Considerations,” Chambliss used both simple and complex cases to illustrate strategies for evaluating new test requests, such as reviewing current literature, consulting practice guidelines, determining whether testing would be reimbursed, and exploring the availability of comparable in-house tests. These cases showcased the importance of communication among multidisciplinary teams and the laboratory to properly evaluate these requests.
To conclude her talk, Chambliss presented the audience with a clinical scenario in which a provider requested six new plasma biomarkers for Alzheimer’s disease. Complicating the matter was an additional request for a comprehensive ATN (amyloid-tau- neurodegeneration) panel, in which there was significant overlap with the individual tests. She described how her institution considered numerous factors, including test utility, cost, and potential for overuse. Ultimately, test orders were restricted to neurology providers in an effort to control access, support appropriate utilization, and prevent unnecessary spending.
Each scenario underscored the tangible benefits of laboratory stewardship, serving as an inspiration for other institutions to adopt similar programs into routine practice. In the end, attendees left the session better equipped to apply what they learned to enhance the quality of patient care and maximize cost-efficiency.
