Diana Cotner
Intermountain Laboratory Services recently received the Patient-Centered Laboratory Utilization Guidance Services (PLUGS) Member of the Year award at the PLUGS 6th annual summit in Seattle. Intermountain was chosen out of a group of at least 90 other hospitals and laboratories across the nation who are PLUGS members.
“Our robust laboratory stewardship team is focused on appropriate testing and partnering with clinicians to improve care,” says Karen Brownell, assistant vice president of Laboratory Services. “Our goal is to get the right tests and the right diagnosis at the right time. This recognition from PLUGS celebrates stewardship in lab testing, efficiency, collaboration, and patient advocacy, as well as reducing waste.”
Intermountain’s laboratory stewardship team, which began in 2018, is cochaired by Eddie Stenehjem, MD, and Sterling Bennett, MD, and involves clinicians in many different areas, along with finance, care transformation information systems (CTIS), SelectHealth, operations, and precision genomics all working together. A subgroup is focused on genetic testing stewardship.
Karen says the lab stewardship team is highly aligned with Intermountain’s mission and providing extraordinary care at the lowest cost. The team looks at the impact of different lab tests and how to get the best results while saving costs to our patients and system.
In one example, clinicians were ordering a large test for respiratory concerns that was costing about $800. “This panel was being overutilized and those costs were being passed to patients,” Karen says. “One clinician, Bert Lopansri, MD, recognized that we were overutilizing a large testing panel and started asking questions as to how we could change usage appropriately.”
The laboratory stewardship team then developed best practices to change behaviors around this testing order. While the test is still an option for providers, the lab team implemented a popup in iCentra to provide decision support and indicate what’s most appropriate for the patient.
“In this case, the test was most appropriate for use with immunosuppressed and certain pediatric patient populations,” Karen says.
Mallory Sdano
Genetic testing is another area that’s supported by the lab stewardship team. The genetic laboratory stewardship committee was started by genetic counselor Katie Dunn in early 2020 and is now chaired by laboratory genetic counselors Mallory Sdano and Laila Andoni.
“Genetic tests can be very nuanced and costly,” says Mallory. “We have a process to review genetic tests that are sent outside the system. Our process is meant to be collaborative with the provider to improve both the provider and patient experience. We want to make sure we’ve ordered the right test to give patients the information they need to live their healthiest lives possible.”
In one case, it was discovered that a duplicate genetic testing panel was ordered for a pediatric patient. Upon reviewing the patient’s chart, Mallory was able to see that the patient already had a test called whole genome sequencing (WGS). This meant that the order for a panel was unnecessary because it was duplicative to the previous WGS. “I was able to talk with the ordering provider about the testing and help them find the WGS results in the patient’s chart so they could get the genetic information they wanted right away,” said Mallory. “By cancelling this testing, we saved $1,500 in unnecessary costs. It was a win-win.”
Mallory says that cost is an important issue, as often the testing costs comes out of the patient’s pocketbooks. In another similar case, a patient’s cumulative savings came to $3,800 by cancelling unnecessary tests.
Karen says the PLUGS organization has helped Intermountain develop best practices in testing and improving care, which started with pediatrics a few years ago and expanded to a broader patient-centered focused.
PLUGS is a laboratory stewardship collaborative within Seattle Children’s Hospital, focused on best practices to improve lab testing, ordering, retrieval, interpretation, and reimbursement. PLUGS and its health system members across the country get together to learn from each other and share best practices. Diana Cotner, rapid response laboratory supervisor at Primary Children’s Hospital and Ted Pysher, MD, were integral to bringing the PLUGS program to Intermountain. They spearheaded the PLUGS genetic testing stewardship program at Primary Children’s, which began about five years ago. The program has built a strong foundation for Intermountain’s current genetic stewardship team.
“I’m thrilled that our Member of the Year winner for this year is Intermountain Healthcare,” says Darci Sternen, laboratory genetic counselor at Seattle Children's Hospital and PLUGS. “This award is selected by the PLUGS leadership team. We choose member institutions that are lab stewardship role models and who’ve utilized our resources and given back to the network.”
Intermountain’s lab stewardship team invites any clinicians or caregivers to bring up tests or conditions they should review. Send your ideas to Karen, Dr. Bennett, or Dr. Stenehjem.