ASCP 2024 Session Showcases Effective Test Utilization Best Practices

The clinical laboratory is critical to promoting and managing the delivery and use of healthcare resources. ASCP—a proponent of patient-centered care and evidence-based medicine—will host a Choosing Wisely Champions session during the ASCP 2024 Annual Meeting on September 6, at 2:30 p.m. (CT) to showcase successful efforts to carefully steward laboratory resources. Elise Occhipinti, MD, FASCP chair of ASCP’s Quality and Patient Safety Steering Committee, will introduce the two 2024 Choosing Wisely Champions and discuss the transition of the Choosing Wisely program from the American Board of Internal Medicine to ASCP. 

Choosing Wisely Champions

Kathryn Golab, DCLS, MLS(ACSP)^CMSH^CM is the clinical specialist in hematology, coagulation and urinalysis with Sentara Healthcare. She is recently finished her studies as a Doctor of Clinical Laboratory Science through Rutgers School of Health Professions at Froedtert and the Medical College of Wisconsin (F&MCW) and worked with multiple interdisciplinary teams throughout her final academic year to improve laboratory ordering and utilization at the point of impact on patient care teams. Choosing Wisely guidelines, as well as other nationally recognized consensus guidelines, provided the backbone of her utilization recommendations to clinicians on patient care rounds.

Dr. Golab participated in the Enterprise Laboratory Stewardship Committee at F&MCW as a laboratory representative and led the development of an initiative to reduce over-ordering of heavy metal blood screening panels in collaboration with the enterprise medical toxicology division. As part of her final academic year, she also performed utilization-based research focused on the ordering and use of peripheral blood flow cytometry.

Using the ASCP Choosing Wisely Guideline related to peripheral blood flow cytometry, she developed a clinical decision support tool within the electronic medical record system that led to a 47-percent reduction in unnecessary peripheral blood flow cytometry requests for patients without a history of hematolymphoid malignancy and increased appropriate utilization from 47 percent to 80 percent. This work was presented as a poster presentation at the ASCP national meeting in September 2024, with plans to publish a journal manuscript with these and additional findings in the near future.

The second Choosing Wisely Champion is the PLUGS^® (Patient-centered Laboratory Utilization Guidance Services) Informatics Committee. It is a laboratory stewardship collaborative whose mission is to improve laboratory test access, ordering, retrieval, interpretation and reimbursement. PLUGS^® is led by a team of experts within Seattle Children’s Hospital & University of Washington who serve as the leaders for the collaborative. PLUGS’s membership comprises a diverse group of laboratory stewardship stakeholders representing hospitals, health systems, laboratories, patient advocacy groups, health and biotechnology companies, and payers.

Allison Chambliss, PhD, DABCC, FADLM will present on behalf of the PLUGS Informatics Committee, which has focused on two important considerations related to practical application of benchmarking: accounting for patient population differences and resource requirements for gathering, collating, and sharing laboratory utilization data across different institutions. Criteria for selecting metrics were defined and three initial benchmarks were developed: vitamin D, thyroid testing, and iron deficiency workups. Practical guidance on retrieving data and calculating the actual metric was included.

A pilot study using these benchmarks revealed significant variations in performance across participating institutions. Institutions with established interventions showed better outcomes against the relevant metrics, highlighting the effectiveness of targeted interventions in improving stewardship. Using these metrics, individual institutions can compare their calculated metrics to the proposed benchmark goals to assess the potential for improvement. The approach and findings were disseminated to the PLUGS® membership at the 2023 and 2024 PLUGS® Summits. They have also spread awareness beyond PLUGS® members through the Clinical Laboratory News Quarterly Focus on Laboratory Stewardship. 

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