Laboratory medicine in the new healthcare environment

Abstract

Abstract:The 21st century challenge is to redesign healthcare systems to be safe, efficient, effective, timely, equitable and patient-centred. Although laboratory medicine is integral to many of these objectives involving prevention, diagnosis, treatment, and managing disease of patients, it suffers from poor visibility as a medical discipline and as a profession and fewer rewards for educational efforts when compared to other medical disciplines. Laboratory scientists are often perceived as managing machinery and equipment, but conversely they need to take a position of shared clinical leadership, showing the role of laboratory tests to guarantee optimal care for patients. This is however challenging because of some reluctance by laboratory professionals to involve themselves in test structuring and requesting and in the inspection of work as it arrives because it is assumed that all requests are clinically necessary; there is a poor communication and integration between clinical wards and laboratory; and, importantly, there is the need for an excellent cultural and scientific background of laboratory professionals for implementing outcome research and to act as knowledge managers and skilled clinical consultants. By combining the unique talent of performing quality laboratory assays with knowledge of the pathophysiologic rationale behind the tests, laboratory professionals have the expertise to advise their clinical colleagues in regard to the appropriate test selection and interpretation of laboratory results, thereby creating opportunities to define the added value and the pivotal role of laboratory medicine on healthcare delivery.

Progress and impact of enzyme measurement standardization

“…The fulfillment of requirements for the applicability of EQAS results in the evaluation of the performance of participating laboratories in terms of traceability of their measurements involves both technical and economic efforts by EQAS organizers that are still limiting their introduction [37,38]. It is, however, clear that these aspects have to be immediately solved since EQAS that meet metrological criteria have unique benefits that add substantial value to the practice of laboratory medicine [2]. This has been shown by Cobbaert et al [39], who, using commutable and RMP-targeted EQAS materials, were able to demonstrate a significant improvement of enzyme standardization in the Netherlands from 2005 to 2010.…”

“…Instead of requesting manufacturers to change, most of us just waits for the new proposals from industry. As mentioned earlier [2], to become relevant in the healthcare environment, laboratory professionals have to change their attitude from one of being defensive to one that is outward looking and innovative.…”

“…[1]. Consequently, the analytical validity and standardization of their measurements have a central role and may become a matter of patient safety, thus potentially affecting the way enzyme tests should be used to provide optimal care [2]. It is now globally recognized that to be accurate and equivalent for long term, laboratory results should be traceable to higher-order references (methods and/or materials) [3].…”

“…Standardization can indeed modify enzyme results and without adequate reference intervals this situation can impair the interpretation of the results and, paradoxically, worsen the patient's outcome [2,21]. The introduction of enzyme reference measurement systems to provide traceable patient results have therefore been followed by the definition of traceable reference intervals to provide more congruent and effective information to clinicians.…”

Strategies to define performance specifications in laboratory medicine: 3 years on from the Milan Strategic Conference

“…Difficulties in directly connecting laboratory testing to clinical outcomes are well known [39]. For this reason, defining PS using "indirect" outcome data (i.e.…”