Laboratory stewardship enters our vocabulary Laboratory stewardship has been in practice by some labs for several years, although interest has grown significantly in the past two years. An article in Journal of Applied Laboratory Medicine, published in October 2017, put laboratory stewardship on the map.2 In January 2019, AACC announced a new quarterly

section on laboratory stewardship in Clinical Laboratory News. Just as with other innovations in laboratories, this one builds on prior building blocks including utilization management and patient safety. Most importantly, laboratory stewardship requires data—and lots of it—in a form that can be analyzed and delivered almost immediately. It provides a framework not only for retrospective reviews but adds the ability to send messages in advance care and point-of-care delivery.

The term “laboratory stewardship” is important

to use because it conveys a growing practice across institutions that focuses on value, not just utilization and costs. Stewardship implies that laboratory managers are taking responsibility for the viability of laboratory resources that have been entrusted to our care. We are likely to gain more engagement by strongly advocating for the protection of a vital resource (the clinical laboratory) and its appropriate role than by simply focusing on utilization. Dr. Gambino relied on chart review, daily rounds,

IDEAS is a five-step model for projects: z

Identify amendable problems; define project charter or scope


Develop project team (may be standing committee)

z Extract, standardize, and analyze data z Apply solutions to the problem (input)


Size the change and reiterate until problem is rectified, resolved (output) with process to assure monitoring; also involves communications.

and generally, one-on-one interactions. Laboratory stewardship relies on “big data.” Specifically, clinical and laboratory data extraction, standardization of data elements, and analysis are core aspects of data use. Data is generally applied to identified problems that can be improved. New tools including artificial intelligence (AI) may also uncover issues that are hidden in the data. Today, the resources to analyze and intervene large data sets exists, as does the financial desire to improve health outcomes and control costs. When the clinical lab applies the strength of the data to address the Triple Aim, laboratorians will likely become more integrated into clinical care teams.

Getting laboratory stewardship well-rooted Laboratory stewardship requires governance with organizational alignment, processes, and procedures. Governance


alignment with hospital committees, as well as internal alignment to the clinical lab. All clinical departments are impacted by laboratory stewardship and broad representation is often helpful. A leadership team can involve fewer individuals to provide overall support without managing activities within each department. Governance typically evolves as the power of laboratory stewardship is recognized. Often, the best


step is to start with small demonstration projects that are likely to succeed. After a few successes, building a sustainable model with broader representation may be appropriate. Finding

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