All Case Examples

Janis Atkinson, MD, FCAP, the medical laboratory director at AMITA Health Saint Francis Hospital in Evanston, Illinois, worked with a systemwide group of executives, quality experts, and clinicians to significantly improve quality through optimizing laboratory testing and leveraging the electronic medical record.

When Joseph Khoury, MD, FCAP, works with a new medical laboratory at an affiliate institution that is joining the MD Anderson Cancer Network, he is part of a multidisciplinary team taking steps to help improve quality by identifying potential process gaps, thriving on the mutual exchange of ideas that ultimately benefits patients and the public within that community.

Molecular diagnostics enable hospital-based laboratories to provide high-impact patient care services that protect and promote the quality and safety of patient care. Pathologist Karen L. Kaul, MD, PhD, FCAP, discusses why some of the emerging uses of molecular diagnostics at NorthShore University HealthSystem are efficient and cost effective and provide value to both the patient and institution.

Partners HealthCare is finding success in fully integrating its 11 hospitals by following a path of collaborative problem solving that encourages creative thinking for more economical, efficient, patient-centered care. As a part of the Partners network, Newton-Wellesley Hospital’s pathologists share the laboratory team’s ideas at a variety of medical staff meetings. Michael J. Misialek, MD, FCAP, recounts how the laboratory billing staff was integral in reducing waste, cost, and unnecessary testing.

Cleveland Clinic’s Laboratory Stewardship Committee uses a multidisciplinary team approach that draws upon resources and personnel within the hospital information system, laboratory, and clinical staff to improve patient care. Laboratory test utilization initiatives introduced since 2011 have saved the Cleveland Clinic $5.0 million—the cost avoidance in 2017 alone was more than $835,000. This teamwork approach has brought best practices and systemwide changes to bridge the connection between systems that work, patient safety, and improved patient care.

Leaders in pathology education scramble to design curricula that keep pace with the science of medicine without losing sight of either their trainees’ need for hands-on experience or the practical constraints that limit the flexibility of their clinical and administrative partners. One program director offers a snapshot of not-unwelcome challenges pathologists in training and their educators encounter. Can reframing pathology training benefit patients, colleagues, and administrators?

Identification and treatment of vitamin D deficiency is important for musculoskeletal and extra-skeletal health. For serum vitamin D testing of at-risk populations, there are well-defined clinical indications, including osteoporosis, malabsorption, fracture, limited effective sun exposure, obesity, and institutionalized individuals, among others. In these individuals it is appropriate to measure vitamin D to determine the dose of oral vitamin D supplementation to reach target levels. Repeat testing to ensure replenishment is also warranted.

Because standards and practices—second nature to pathologists—are so readily scaled up and transferred to other domains, pathologists are well prepared to take on broad, interdisciplinary roles. The career path of Stephanie Mayfield Gibson, MD, FCAP, into population health illustrates how pathologists’ roles are evolving and are poised to accelerate.

Using metrics to pivot for change, Amanda E. Haynes, DO, FCAP, collaborated with her team to motivate a system-wide effort that saved more than $1 million in blood acquisition costs across Pennsylvania’s Geisinger Health System.

Finding ways to monitor and manage the constant stream of information that may or may not be actionable to clinicians is a prime focus for Cordelia E. Sever, MD, FCAP, and her team at Pathology Associates of Albuquerque. They are coming to grips with the need for more refined, targeted, and dynamic information management that benefits interspecialty collaboration—and the patient.

The Outpatient Cytopathology Center in Johnson City, Tennessee, grew into a thriving business, attributed in large part to its concentrated focus on pathologist-led services that integrate clinical care and prompt reporting of test results. CAP member Susan D. Rollins, MD, FCAP, and her two partners deliver a distinct value to patients and referring physicians alike in which FNA and surgical biopsies are among the services they perform and interpret.

As a systems-oriented physician, Alexis Byrne Carter, MD, FCAP, uses her pathologist’s curiosity and clinician’s interest in how people think as she observes, evaluates, and negotiates on behalf of patients to remove ambiguity in systems and processes.

Ebola Virus Disease put the biocontainment facility at Emory University Hospital to the test and put an emphasis on team integration and safety procedures.

Type 2 diabetes mellitus (T2DM) is a dangerous disease out of control: US Centers for Disease Control and Prevention (CDC) data for 2007–2010 showed that 47.5% of adults with diabetes had average blood glucose (HbA1c) levels exceeding the American Diabetes Association (ADA) target of 7.0%. The ADA estimates that T2DM accounts for $1 of every $5 spent on health care in the United States, and the CDC puts diabetes prevalence at 8% of the US population. A December 2014 ADA report pointed to a 74% increase in the cost of prediabetes and an 82% increase in the cost of undiagnosed diabetes between 2007 and 2012.

Practice guidelines are translational research writ large: tools that gain value as they enable evidence-based care. When more patients get better quicker because standardized procedures produce more precise and useful test results, everybody wins.

Many physicians worry about whether patients with chronic pain take their medication incorrectly or in combination with other substances, but few have the toxicology expertise required to know for sure. Physicians on staff at Tufts Medical Center are fortunate in this regard. Hospital guidelines to address ambulatory management of patients with chronic pain include instructions for follow-up that feature a number to call for further advice. That number connects them to the telephone of Barbarajean Magnani, PhD, MD, FCAP, chair and pathologist-in-chief in Tuft’s Department of Pathology and Laboratory Medicine. Dr. Magnani gets a lot of calls.

Pathologists are creating three complementary approaches to complex clinical laboratory testing—multidisciplinary diagnostic teams, standardized order protocols, and synthetic test reports. Each has been shown to improve the quality of care and patient experience while educating clinicians and reducing the over-and underutilization of laboratory tests.

Pathologists and other laboratory professionals engineer systems-oriented solutions that benefit large populations. Many positive process changes involve small steps that draw little attention. Screening all new admissions for Methicillin-resistant Staphylococcus aureus (MRSA), for example, may have sounded like a bother until clinical experience demonstrated the time and money saved downstream in hospital operations.

The most persuasive arguments for the value of pathology will be direct, concrete, and evidence based.