Labor Relations

Adarsh K. Khalsa; Michael Santa Cruz; Michael A. Saubolle

doi:10.1128/9781555817282.ch26

Chapter 26 : Labor Relations

Authors: Adarsh K. Khalsa, Michael Santa Cruz, Michael A. Saubolle

Content Type: Reference

Publication Year: 2014

Category: Clinical Microbiology

Book DOI: 10.1128/9781555817282

Chapter DOI: 10.1128/9781555817282.ch26

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:

Labor Relations, Page 1 of 2

< Previous page | Next page > /docserver/preview/fulltext/10.1128/9781555817282/9781555817275_Chap26-1.gif /docserver/preview/fulltext/10.1128/9781555817282/9781555817275_Chap26-2.gif

Abstract:

This chapter aims to familiarize the readers with the principles of selection, assessment, and incorporation of diagnostic tests. It reviews principles of test evaluation and utilization and their effect on patient outcomes. The chapter describes major elements of requisition and test menu formats. It discusses the principles of formatting of reports of test results. The chapter analyses the necessity for report interpretation and consultation comments. It reviews the needs for record storage. Preanalytic and postanalytic activities are crucial to accurate laboratory results and to their appropriate interpretation for patient care. The preanalytic phase refers to all steps taken before actual testing is performed on a patient’s specimen. It includes test selection, test ordering, patient/specimen identification, specimen collection and transportation, specimen processing and preparation, as well as appropriate specimen storage prior to testing. Effective laboratory test menu formats and comprehensive listing enhance appropriate test ordering. Referral of specimens to reference laboratories for additional or otherwise esoteric testing is included in this phase. The postanalytic phase refers to all steps taken after actual testing is performed on a patient’s specimen. It includes the reporting of test results, report review, result archiving, and specimen storage, as well as assessment of all postanalytic activities. Adequate explanation and interpretation of result reports is important and can greatly influence patient care and outcomes.

Citation: Khalsa A, Santa Cruz M, Saubolle M. 2014. Labor Relations, p 488-505. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch26

Highlighted Text: Show | Hide

Full text loading...

Figures

Labor Relations

[com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/author/10.1128/9781555817282.chap26-1,webId=/content/author/10.1128/9781555817282.chap26-1,properties={foaf_givenname=Adarsh K., foaf_name=Adarsh K. Khalsa, foaf_surname=Khalsa}], com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/author/10.1128/9781555817282.chap26-2,webId=/content/author/10.1128/9781555817282.chap26-2,properties={foaf_givenname=Michael, foaf_name=Michael Santa Cruz, foaf_surname=Santa Cruz}], com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/author/10.1128/9781555817282.chap26-3,webId=/content/author/10.1128/9781555817282.chap26-3,properties={foaf_givenname=Michael A., foaf_name=Michael A. Saubolle, foaf_surname=Saubolle}]]

/content/10.1128/9781555817282.chap26.fig26-1

Figure 26.1

An example of information and instructions in a laboratory users’ manual for collection and submission of specimens for evaluation of whooping cough. doi:10.1128/9781555817282.ch26.f1

10.1128/9781555817282/fig26-1_thmb.gif

10.1128/9781555817282/fig26-1.gif

Figure 26.1

An example of information and instructions in a laboratory users’ manual for collection and submission of specimens for evaluation of whooping cough. doi:10.1128/9781555817282.ch26.f1

/content/10.1128/9781555817282.chap26.fig26-2

Figure 26.2

Sample list of textual “value-added” comments attached to specific laboratory reports. doi:10.1128/9781555817282.ch26.f2

10.1128/9781555817282/fig26-2_thmb.gif

10.1128/9781555817282/fig26-2.gif

Figure 26.2

Sample list of textual “value-added” comments attached to specific laboratory reports. doi:10.1128/9781555817282.ch26.f2

References

/content/book/10.1128/9781555817282.chap26

1. American Society for Clinical Pathology. 2002. Direct access testing (policy number 01-02). http://www.ascp.org/pdf/DirectAccessTesting.aspx, accessed September 17, 2012.

2. Bailey, M. K.,, L. Blacklidge,, C. M. Day,, L. S. Garcia,, D. Parks,, and T. Street. 1994. Keep tests in or send them out? Med. Lab. Obs. 26: 46– 47.

3. Bailey, M. K.,, L. Blacklidge,, C. M. Day,, L. S. Garcia,, D. Parks,, and T. Street. 1995. how to curb physicians’ excessive testing. Med. Lab. Obs. 27: 69.

4. Barenfanger, J. 2001. Clinical microbiology laboratories can directly benefit patients. ASM News 67: 71– 77.

5. Barenfanger, J.,, M. A. Short,, and A. A. Groesch. 2001. Improved antimicrobial interventions have benefits. J. Clin. Microbiol. 39: 2823– 2828. [PubMed][CrossRef]

6. Baron, E. J. 1996. Development in laboratory informatics. Clin. Microbiol. Newsl. 18: 65– 70.

7. Bissell, M. G., 2000. Introduction: what's in a laboratory outcome?, p. 3– 10. In M. G. Bissell (ed.), Laboratory-Related Measures of Patient Outcomes: An Introduction. American Association for Clinical Chemistry Press, Washington, DC.

8. Cannon, B.,, and M. Lee. 1996. Clinical laboratory tests: application to daily practice. J. Am. Pharm. Assoc. NS36: 668– 679. [PubMed]

9. Chassin, M. R. 1996. Quality of healthcare. Part 3. Improving the quality of care. N. Engl. J. Med. 335: 1060– 1062. [PubMed][CrossRef]

10. Clark, R. B., , et al 2009. Cumitech 31A, Verification and validation of procedures in the clinical microbiology laboratory. Coordinating ed., S. E. Sharp. ASM Press, Washington, DC.

11. Clinical and Laboratory Standards Institute. 2011. Quality Management System: A Model for Laboratory Services; Approved Guideline, 4th ed., CLSI Document GP26-A4. CLSI, Wayne, PA.

12. College of American Pathologists. Education: CAP patient outcome templates. http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=outcomes%2Fpatient_outcome_templates%2Fpot.html&_state=maximized&_pageLabel=cntvwr ( accessed July 1, 2013).

13. DeKay, M. L.,, and D. A. Asch. 1998. Is the defensive use of diagnostic tests good for patients, or bad? Med. Decis. Making 18: 19– 27. [PubMed]

14. Department of Health and Human Services. 2003. Medicare, Medicaid and CLIA programs: laboratory requirements relating to quality systems and certain personnel qualifications. Fed. Regist. 68: 3639– 3713. [PubMed]

15. Epstein, A. M.,, and B. J. McNeil. 1986. Relationship of beliefs and behavior in test ordering. Am. J. Med. 80: 865– 870. [PubMed]

16. Fischbach, F. 2000. A Manual of Laboratory and Diagnostic Tests, 6th ed., p. 1– 33. Lippincott Williams & Wilkins, Philadelphia, PA.

17. Garcia, L. S.,, G. W. Procop,, G. D. Roberts,, and R. B. Thomson,. 1998. Selection of diagnostic tests, p. 60– 63. In B. A. Forbes,, D. F. Sahm,, and A. S. Weissfeld (ed.), Bailey & Scott's Diagnostic Microbiology. Mosby, Inc., St. Louis, MO.

18. Gums, J. G.,, R. W. Yancey, Jr.,, C. A. Hamilton,, and P. S. Kubilis. 1999. A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team. Pharmacotherapy 19: 1369– 1377. [PubMed]

19. Halsey, J. F. 2000. Direct access testing in the clinical laboratory: should laboratories offer testing services directly to the consumer? Clin. Leadersh. Manag. Rev. 14: 261– 266. [PubMed]

20. Hawkins, H. H.,, R. W. Hankins,, and E. Johnson. 1999. A computerized physician order entry system for the promotion of ordering compliance and appropriate test utilization. J. Healthcare Inf. Manag. 13: 63– 72. [PubMed]

21. Health Care Financing Administration. 1992. Medicare, Medicaid, and CLIA programs. Regulations implementing the Clinical Laboratory Improvement Amendments of 1988 (CLIA). Fed. Regist. 57: 7002– 7186. [PubMed]

22. Heffner, D. K.,, and C. F. Adair. 1999. Clarity on the diagnosis line (the devil is in the details). Ann. Diagn. Pathol. 3: 187– 191. [PubMed][CrossRef]

23. Howanitz, J. H.,, and P. J. Howanitz,. 1991. Principles of laboratory medicine, p. 1–10. In J. H. Howanitz, and P. J. Howanitz (ed.), Laboratory Medicine: Test Selection and Interpretation. Churchill Livingston Inc., New York, NY.

24. Inlander, C. B. Direct access testing: a consumer group's perspective. http://wwwn.cdc.gov/cliac/pdf/addenda/cliac0303/inlander0303n.pdf, accessed September 21, 2012.

25. Jacobs, I. A.,, K. Kelly,, C. Valenziano,, A. H. Chevinsky,, J. Pawar,, and C. Jones. 2000. Cost savings associated with changes in routine laboratory test ordered for victims of trauma. Am. Surg. 66: 579– 584. [PubMed]

26. Joint Commission on Accreditation of Healthcare Organizations. 1990. Accreditation Manual of Hospitals. p. 137– 138. Joint Commission on Accreditation of healthcare Organizations, Chicago, IL.

27. Joint Commission on Accreditation of Healthcare Organizations. 1996. Comprehensive Accreditation Manual for Pathology and Laboratory Services. Joint Commission on Accreditation of healthcare Organizations, Oakbrook Terrace, IL.

28. Kazmierczak, S. C. 1999. Statistical techniques for evaluating the diagnostic utility of laboratory tests. Clin. Chem. Lab. Med. 37: 1001– 1009. [PubMed][CrossRef]

29. Kilgore, M.,, L. Hensley,, C. Howard,, J. Craft,, and J. A. Smith. 1999. Curbing overutilization: the silver lining to hCFA compliance. Med. Lab. Obs. 31: 26– 28. [PubMed]

30. Kollef, M. H.,, and S. Ward. 1998. The influence of mini-BAL cultures on patient outcomes. Chest 113: 412– 420. [PubMed]

31. Labeau, K. M.,, M. Simon,, and S. J. Steindel. 2011. Clinical laboratory test menu changes in the Pacific Northwest: an evaluation of the dynamics of change. Clin. Leadersh. Manag. Rev. 15: 16– 22. [PubMed]

32. LaRocco, M. 1995. Quality and productivity in the microbiology laboratory: continuous quality improvement. Clin. Microbiol. Newsl. 17: 129– 131.

33. Lewandrowski, K.,, and D. MacMillan. 2003. Selection of a clinical reference laboratory: general principles and some observations from Massachusetts General hospital. Clin. Microbiol. Newsl. 25: 33– 37.

34. Linehan, B. J.,, M. M. El-Nageh,, S. Cordner,, and A. Richter. 2002. Ethics in laboratory medicine, p. 134– 142. In K. D. McClatchey (ed.), Clinical Laboratory Medicine, 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA.

35. Lundberg, G. D. 1999. how clinicians should use the diagnostic laboratory in a changing medical world. Clin. Chim. Acta 280: 3– 11. [PubMed]

36. Marcon, M. J. 2003. “Value-added” reporting in clinical microbiology: using computer-based textual reports and comments as an aid to communicating appropriate utilization and application of test results. Clin. Microbiol. Newsl. 25: 25– 31.

37. Mayer, M. 1991. Unnecessary laboratory tests in diagnosis and treatment. Harefuah 120: 66– 69. [PubMed]

38. NCCLS. 1998. Basic Cost Accounting for Clinical Services: Approved Guideline. NCCLS document GP11-A. NCCLS, Wayne, PA.

39. Nicoll, C. D.,, and M. Pignone,. 2002. Diagnostic testing and medical decision making, p. 1669– 1680. In L. M. Tierney, Jr.,, S. J. McPhee,, and M. A. Papadakis (ed.), 2002 Current Medical Diagnosis & Treatment, 41st ed. Lange Medical Books/McGraw hill, New York, NY.

40. Pande, P. S.,, R. P. Neuman,, and R. R. Cavanagh. 2000. The Six Sigma Way: How GE, Motorola, and Other Top Companies are Honing Their Performance. McGraw-hill, New York, NY.

41. Plebani, M. 1999. The changing face of clinical laboratories. Clin. Chem. Lab. Med. 37: 711– 717. [PubMed][CrossRef]

42. Rodriguez, F. 1996. Improve microbiology procedures and utilization while saving money. Med. Lab. Obs. 28: 60– 64. [PubMed]

43. Ruangkanchanasetr, S. 1993. Laboratory investigation utilization in pediatric out-patient department Ramathibodi hospital. J. Med. Assoc. Thai. 76( Suppl 2): 194– 208. [PubMed]

44. Schubart, J. R.,, C. E. Fowler,, G. R. Donowitz,, and A. F. Connors, Jr. 2001. Algorithm-based decision rules to safely reduce laboratory test ordering. Medinfo 10: 523– 527.

45. Sewell, D.,, and J. D. MacLowry,. 1999. Laboratory management, p. 4– 22. In P. R. Murray,, E. J. Baron,, M. A. Pfaller,, F. C. Tenover,, and R. H. Yolken (ed.), Manual of Clinical Microbiology, 7th ed. ASM Press, Washington, DC.

46. Shimetani, N. 1998. Consultation on laboratory information: from the perspectives of clinical pathologists and medical technologists. Rinsho Byori 46: 987– 993. [PubMed]

47. Silverstein, J. C.,, and A. S. Rothschild. 1999. Clinical perspectives on the modern laboratory. Clin. Lab. Med. 19: 421– 432. [PubMed]

48. Silverstein, M. D., 2000. Laboratory tests for case-finding and screening for disease in the ambulatory setting, p. 129– 146. In M. G. Bissell (ed.), Laboratory-Related Measures of Patient Outcomes: An Introduction. American Association for Clinical Chemistry Press, Washington, DC.

49. Southwick, K. 2002. Antibiotic alert: labs, pharmacies take on cost and misuse. CAP Today 16: 62– 71.

50. Stapleton S. 2003. Do-it-themselves diagnosis: patients pick their tests. Am. Med. News, amednews.com, accessed September 21, 2012.

51. Statland, B. E. 1994. Cost/benefit of screening. Med. Lab. Obs. 26: 11.

52. Studnicki, J.,, D. D. Bradham,, J. Marshburn,, P. R. Foulis,, and J. V. Straumfjord. 1993. A feedback system for reducing excessive laboratory tests. Arch. Pathol. Lab. Med. 117: 35– 39. [PubMed]

53. Thomas, J. G. 2000. Outcomes assessment: empowerment for microbiologists. Adv. Lab. 9: 54– 60.

54. Toubert, M. E.,, S. Chevret,, B. Cassinat,, M. H. Schlageter,, J. P. Beressi,, and J. D. Rain. 2000. From guidelines to hospital practice: reducing inappropriate ordering of thyroid hormone and antibody tests. Eur. J. Endocrinol. 142: 605– 610. [PubMed]

55. Travers, E. M.,, and K. D. McClatchey,. 2002. Basic laboratory management, p. 3– 48. In K. D. McClatchey (ed.), Clinical Laboratory Medicine, 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA.

56. Travers, E. M., 2002. Business management of the clinical laboratory, p. 49– 77. In K. D. McClatchey (ed.), Clinical Laboratory Medicine, 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA.

57. Valenstein, P.,, M. Pfaller,, and M. Yungbluth. 1996. The use and abuse of routine stool microbiology: a College of American Pathologists Q-probes study of 601 institutions. Arch. Pathol. Lab. Med. 120: 206– 211. [PubMed]

58. Winkens, R. A. G.,, P. Pop,, A. M. A. Bugter-Maessen,, R. P. T. M. Grol,, A. D. M. Kester,, G. H. M. I. Beusmans,, and J. A. Knottnerus. 1995. Randomized controlled trial of routine individual feedback to improve rationality and reduce numbers of test requests. Lancet 345: 498– 502. [PubMed]

59. Wong, E. T. 1985. Cost-effective use of laboratory tests: a joint responsibility of clinicians and laboratorians. Clin. Lab. Med. 5: 665– 672. [PubMed]

Tables

Labor Relations

/content/10.1128/9781555817282.chap26.tab26-1

Table 26.1

Processes in the clinical laboratory: path of workflow a , b

a Path of workflow: sequential sum of all preanalytical, analytical, and postanalytical processes, beginning with test order and culminating with laboratory data output.

b Compiled from references 11 and 21.

10.1128/9781555817282/tab26-1_thmb.gif

10.1128/9781555817282/tab26-1.gif

Table 26.1

Processes in the clinical laboratory: path of workflow a , b

a Path of workflow: sequential sum of all preanalytical, analytical, and postanalytical processes, beginning with test order and culminating with laboratory data output.

b Compiled from references 11 and 21.

/content/10.1128/9781555817282.chap26.tab26-2

Table 26.2

Partial list of guidelines and regulatory accreditation requirements a

a For additional description and listing see CAP Checklist Updates, 2009 LAP Audioconference Series, sponsored by the Commission of Laboratory Accreditation of the College of American Pathologists (CAP) at www.cap.org (accessed November 12, 2012).

10.1128/9781555817282/tab26-2_thmb.gif

10.1128/9781555817282/tab26-2.gif

Table 26.2

Partial list of guidelines and regulatory accreditation requirements a

/content/10.1128/9781555817282.chap26.tab26-3

Table 26.3

Applications of laboratory tests a

a Adapted from references 16 and 39.

10.1128/9781555817282/tab26-3_thmb.gif

10.1128/9781555817282/tab26-3.gif

Table 26.3

Applications of laboratory tests a

a Adapted from references 16 and 39.

/content/10.1128/9781555817282.chap26.tab26-4

Table 26.4

Properties of useful diagnostic tests a

a Adapted from references 16 and 39.

10.1128/9781555817282/tab26-4_thmb.gif

10.1128/9781555817282/tab26-4.gif

Table 26.4

Properties of useful diagnostic tests a

a Adapted from references 16 and 39.

/content/10.1128/9781555817282.chap26.tab26-5

Table 26.5

Parameters for ideal settings for screening tests

a Adapted from reference 39.

10.1128/9781555817282/tab26-5_thmb.gif

10.1128/9781555817282/tab26-5.gif

Table 26.5

Parameters for ideal settings for screening tests

a Adapted from reference 39.

/content/10.1128/9781555817282.chap26.tab26-6

Table 26.6

Pros and cons of direct access testing (DAT) a

a See references. 1, 23, and 50.

10.1128/9781555817282/tab26-6_thmb.gif

10.1128/9781555817282/tab26-6.gif

Table 26.6

Pros and cons of direct access testing (DAT) a

a See references. 1, 23, and 50.

/content/10.1128/9781555817282.chap26.tab26-7

Table 26.7

Factors affecting the decision to implement or discontinue a test

10.1128/9781555817282/tab26-7_thmb.gif

10.1128/9781555817282/tab26-7.gif

Table 26.7

Factors affecting the decision to implement or discontinue a test

/content/10.1128/9781555817282.chap26.tab26-8

Table 26.8

Demographic information needed on test requisition a

a See reference 21.

10.1128/9781555817282/tab26-8_thmb.gif

10.1128/9781555817282/tab26-8.gif

Table 26.8

Demographic information needed on test requisition a

a See reference 21.

/content/10.1128/9781555817282.chap26.tab26-9

Table 26.9

Areas that should be reviewed or evaluated in quality assessment of postanalytic systems a

a See references 14 and 21.

10.1128/9781555817282/tab26-9_thmb.gif

10.1128/9781555817282/tab26-9.gif

Table 26.9

Areas that should be reviewed or evaluated in quality assessment of postanalytic systems a

a See references 14 and 21.

/content/10.1128/9781555817282.chap26.tab26-10

Table 26.10

Example of specimen retention requirements by regulatory agency

10.1128/9781555817282/tab26-10_thmb.gif

10.1128/9781555817282/tab26-10.gif

Table 26.10

Example of specimen retention requirements by regulatory agency