ASCP’s North Star: Quality and Patient Safety

By Susan Montgomery and Matthew Schulze - July 09, 2024

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“Quality should always be the North Star in laboratory medicine. It should drive every decision we make,” says Elise Occhipinti, MD, FASCP, Chair of ASCP’s Quality and Patient Safety Committee, and Chair of Clinical Pathology and Laboratory Medical Director of Ochsner Jefferson Highway Hospital, in New Orleans, LA. “In the field of pathology and laboratory medicine, quality includes reducing waste and unnecessary testing. When you reduce waste, you automatically increase quality and, in so doing, you also improve patient safety.”  

As chair of the Committee, Dr. Occhipinti oversees three subcommittees that focus on   effective test utilization, laboratory data analytics, and staffing metrics. Each subcommittee has been tasked with not only keeping quality as their North Star as they work to improve patient safety through their activities, but also to leverage the high-quality standards the laboratory sets for itself to drive superior performance throughout healthcare.   

Dr. Occhipinti recently reflected on her tenure as chair of the committee over the past year and a half, where it began and where it is headed, and discussed the efforts the committee is currently focusing on.  

Effective test utilization 

ASCP’s Effective Test Utilization Initiative began in 2012, as part of the Choosing Wisely campaign spearheaded by the ABIM Foundation. The goal was to raise awareness about test overuse and to encourage clinicians to discuss best test options with patients. Over the past decade, several dozen medical societies became involved and recommended tests that should be reviewed for possible overuse. The ABIM Foundation selected which test recommendations to accept and post on its Choosing Wisely website. After a highly successful 10-year awareness campaign, the ABIM Foundation decided to sunset the Choosing Wisely initiative.  

Due to the program's success and its positive impact on patient care, ASCP decided to continue its Effective Test Utilization campaign. “We want to keep this going. The laboratory community really liked the initiative and used the recommendations to effect change in their laboratories,” Dr. Occhipinti says. “Our committee is trying to curate the tests that were submitted over the past decade to see if they need to be updated.”  

This spring, ASCP’s effective test utilization subcommittee put out a call for organizations and health systems to suggest additional tests that should be re-evaluated. Out of many submissions, including submissions from partner organizations such as the American Society for Microbiology, the subcommittee selected the most relevant, which spanned the gamut from cancer diagnostics to sepsis markers, and several other areas. The list will be published later this year. In addition, the subcommittee will host an education session at the ASCP 2024 Annual Meeting, Sept. 4-6, featuring Choosing Wisely Champions, individuals or health teams that have been selected for recognition for the successful efforts to reduce test overuse. 

Looking ahead, the subcommittee hopes to expand the program. “We want to curate the experts we have within ASCP’s membership,” Dr. Occhipinti says. “We put out a call for members who would be interested in serving as subject matter experts in various areas so that they could speak to the issue of test overuse in the laboratory. We have gotten more than 100 people to be part of a new advisory board. Now, we will go through this roster of experts and create areas of subspecialty. We will tap these experts to review our old lists of guidelines to ensure they are still current, and they will also help us to develop new recommendations.” 

In the past, Dr. Occhipinti describes the Choosing Wisely recommendations as being “dogmatic. Don’t do this order, don’t do that order,” she says. “We want to change that to give guidance as opposed to being heavy handed. We want to give people real guidance on how to effect change. So, if we suggest they don’t do, say, two specific orders at the same time, we want to also suggest what they can do instead.” 

“We want to give them tools, such as, here is how you pull your order data, and this is what that data should look like,” she adds. “If you tell a doctor they can’t use a certain test, they may resist that and do what they want to do anyway. By providing them with an alternative test that could perform even more effectively, we are providing them with a new tool and guidance.” 

The committee is looking at partnering with other organizations to gain practical knowledge while sharing ASCP’s ability to reach a broad audience.  

Laboratory data analytics 

In today’s healthcare environment, the demand for performance is a primary concern as health systems seek to improve the quality of care while reigning in ever-increasing costs. This need has fueled demand for benchmarking to measure the medical laboratory’s performance against that of other health systems. 

The National Patient Quality Registry, or NPQR, is a national database where laboratories send their LIS data to be standardized, analyzed, and benchmarked. Sachin Gupta, PhD, MBA, MT(ASCPi)MB, LSSBB, CPHQ, scientific director for the ASCP Center for Quality and Patient Safety, leads a team of ASCP staff that has developed algorithms and dashboards that examine metrics on turnaround times, volumes, and test utilization, among other things.

“NPQR is a great way to assess performance, and it can drill down to even a specific physician level, a specific test, or laboratory,” Dr. Occhipinti says. “It is a comprehensive database and is really growing. We have quite a few major hospitals that are already using it. Some of them have multiple satellite facilities. We are using this data to create more quality guidance for labs through examining national trends and setting practical benchmarks.”  

Quality and patient safety initiative  

An initiative of ASCP and The Joint Commission, the Leading Laboratories Recognition Program shines a spotlight on laboratory teams that have demonstrated exemplary leadership and positively impacted quality patient outcomes through innovative best practices. This one-of-a-kind designation also helps increase visibility for laboratories and their vital role in a patient’s healthcare journey.  

Leading Laboratories was developed and refined by laboratory leaders. The designation is accomplished through a set of criteria designed to quantify and exhibit excellence in four key components: 

  • Elevating quality outcomes 

  • Supporting professional development 

  • Cultivating trusted leadership 

  • Promoting laboratory visibility 

This designation sets the gold standard for laboratory excellence, providing recognition of a laboratory’s meaningful achievements in improving patient outcomes; evidence of a laboratory’s commitment to the necessary ongoing professional development of its team; and proof of laboratory leadership’s dedication to their team and to patients.  

The Leading Laboratories Recognition Program also provides a roadmap to help laboratories on their journey to achieve this designation. This recognition supports ASCP and The Joint Commission’s shared mission of patient safety and quality, while providing another way to confirm laboratories’ essential role in the continuum of care across all healthcare settings. 

“There are some health systems that have taken their quality initiatives to an even higher level, by voluntarily submitting to having evidence of their lab’s activities reviewed and evaluated for the program,” Dr. Occhipinti says. “The Leading Laboratories designation is a feather in the cap of the laboratories that are meeting more stringent quality goals.”  

Building systems that enhance quality 

Collectively, the Quality and Patient Safety Committee’s three subcommittees—test utilization, laboratory data analytics, and staffing metrics—serve to support laboratories in operating efficiently while setting a high standard for quality.  The road toward creating new systems that enhance quality improvement takes time.  

“Ultimately,” Dr. Occhipini says, “ASCP wants to help our members to get their leadership to see the overall value that the entire laboratory team brings to their health system.”