HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lehmann, C. A. Search for Related Content PubMed Articles by Lehmann, C. A.

The Hitchhiker’s Guide to Improving Efficiency in the Clinical Laboratory. F.L. Kiechle and R.I. Main. Washington, DC: AACC Press, 2002, 142 pp., $25.00 ($20.00 AACC members), softcover. ISBN 1-890883-72-7.

State University of New York at Stony Brook Health Sciences Center L2, 049 Stony Brook, NY 11794-8200

This is a well-written text that provides the reader with insight on how to deal with changes in the hospital laboratory. The primary focus of the text is to offer recommendations on how to improve the efficiency of the laboratory. The first chapter, entitled "So-Here We Are!", describes two major challenges for the laboratory in the current healthcare environment: decreased reimbursement and personnel availability. Using an historical approach, the authors describe the evolution of reimbursement and the impact of managed care. In addition, the chapter presents 22 years of inpatient testing volume data with occupancy rate, length of stay, total number of inpatient discharges, and laboratory tests per discharges from the department of clinical pathology at William Beaumont Hospital to demonstrate the impact of managed care on these variables. The authors approach the personnel availability issue by describing the many reasons for its decline (e.g., job satisfaction and program closures) as well as suggestions for potential solutions. I found it remarkable that the authors had provided me with a good understanding of the topics in just 5 pages. This is accomplished only through intensive research of the topics and good writing.

View larger version (100K): [in this window] [in a new window]   Figure 1.

The following chapter, entitled "Now What?", really is about developing a plan of action to help solve problems. The chapter offers examples of tools (e.g., flow diagram and cost-effectiveness analysis) that enable individuals to view the present process and predict the cost of a test. Important issues around testing, such as turnaround time and possible impacts on clinic services, are addressed. After a plan is conceptualized, the authors present ways to implement the plan as well as potential barriers. I enjoyed the section on myths, especially those related to the laboratory. The chapter ends with a discussion on monitoring the outcome of the implemented change.

Chapter three provides an excellent example of a plan to expand core business. The authors describe how their facility got started, who they presented the plan to, and the role of an outside consultant. A summary of the benefits of expanding their outreach program is presented, followed by the plan of implementation along with outcomes. Data demonstrating the impact the plan had on increased clients and procedures are presented. The authors also describe how and why they joined a regional laboratory network and again provide supporting data.

Chapter four discusses merger or consolidation models. I loved the chapter title, "Shrink Wrap". The authors also enter this topic with a wonderful line: "The nattering nabobs of negativism arise to conduct a cantata of contrapuntal cacophony". The obvious benefits of consolidation are well described. I was pleased to see that the primary focus covers the more difficult topics (e.g., politics and competing goals). A difficult topic presented well.

Chapter five’s theme is workstation consolidation. Topics include changes in chemistry technology, core laboratory, workflow analysis, modular automation, and total automation. The heart of this chapter really focuses on total automation vs modular automation. Once again the authors use their own institution as a case study and present compelling data in favor of modular automation.

The pros and cons of point-of-care testing (POCT) are described and well documented in chapter six. Topics covering regulatory guidelines, successful implementation, and management plans are presented. The chapter provides an excellent section on the roles and responsibilities of the POCT coordinator, quality assurance, and training nonlaboratory personnel. There is a good section on cost analysis that covers direct and indirect costs of POCT vs central laboratory. An interesting section on defect-rate inclusion analysis points out the costs associated with poor turnaround time. The demonstration of internal and external failure rates and their impact offer interesting cost scenarios. This is a strong chapter and offers excellent tools for plans that include POCT in a variety of settings.

Chapter seven continues the discussion on laboratory personnel and is timely and makes some excellent points about workforce diversification. A patient-focused care approach is presented along with examples of the laboratory’s role. The authors provide excellent data describing the percentages of high- and moderate-complexity tests for laboratory sections along with ratios of medical laboratory technicians to medical technologists.

Every laboratory manager should read chapter eight on the economics of healthcare in a managed care environment. The authors describe managed care products, such as the preferred provider organization (PPO) and health maintenance organization (HMO). The function, member contribution, and provider structure (e.g., HMO physician gatekeeper) of each product is described. Provider reimbursement methodologies are presented along with a figure demonstrating the provider’s perspective of financial risk by payment method. The authors offer insight for those who are involved in negotiating managed care contracts as well as determining costs and reimbursement rates. A very strong segment of this chapter deals with evaluating contract terms. This section provides a list of key questions for reviewing managed care contracts.

Chapter nine, entitled "Search for the Horizon", is short but pulls the lessons from the other chapters to help us make better decisions in the future. The following sentence exemplifies its theme: "Each plan for improving laboratory efficiency requires careful evaluation before implementation".

Overall I found this to be an excellent text. It was easy to read and provided a great deal of information and guidance for a text that is only 132 pages long. This book is a must for all laboratory managers, and I highly recommend it for all laboratorians and laboratory students.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lehmann, C. A. Search for Related Content PubMed Articles by Lehmann, C. A.