Integration of the CLS Doctorate into the Healthcare Organization

Clinical Laboratory Science, Summer 2009 by Montoya, Isaac, Kimball, Olive

OBJECTIVE: A review of how the doctorally prepared CLS fits into the healthcare organization.

DESIGN: Literature review.

BACKGROUND: Numerous national studies have called for a reshaping of the health care delivery system and the need to improve patient outcomes. Because of unprecedented advances in laboratory related technology as well as the need for economic retrenchment strategies in health care, with its significant influence on patient care, the laboratory has become the subject of intensive study. It has been concluded that the traditional organizational structure of the laboratory information process and the required personnel skills both need rethinking. In order to foster change in the laboratory, an advanced degreed CLS laboratory professional is needed, one already equipped with a broad scientific base developed via a baccalaureate/masters level of education.

CONCLUSION: With the addition of advanced technical expertise, basic medical skills, data interpretation skills and patient interaction abilities, and medical research experience, this laboratory professional can enhance the effective and efficient use of laboratory information and ultimately improve patient care. The clinical doctorates in CLS are educationally and experientially prepared to recommend support and enhance appropriate testing. They translate and transform complex laboratory data into an understandable product necessary for clinicians to be able to assess the validity of current and new assays to ensure better patient care. In addition, they assist in reducing questionable test usage, thereby reducing costs for both the patient and the laboratory.

INDEX TERMS: Clinical Doctorate, Clinical Laboratory Scientist, Pathologist

Clin Lab Sci 2009;22(3):136

INTRODUCTION

The velocity of change in health care has increased and there is a growing need to shift the emphasis from how laboratory information services are delivered (i.e. test results) to a focus on their direct contribution to patient care.1 Without a significant change in the way that these services are rendered, the increasing personnel shortages at all levels may foster the factory mentality in the laboratory to the detriment of patient care.2 Further, without additional understanding of new testing capabilities and constraints, it may be left to clinicians to rely on outdated and incomplete information when ordering tests. This would increase the use of inappropriate and multiple tests, thus increasing costs.

Addressing these laboratory issues is paramount to improving patient care and is critically important to economic considerations. It is evident that there is no organizational model that previously worked and that now works effectively and efficiently.3 The breadth and depth of laboratory services have dramatically expanded to the point that the need for a new professional with additional professional skills has been demonstrated.4

Laboratory professionals at all levels must be able to provide assurance that the correct test is performed on the right person, at die right time, as well as tliat die test produces accurate and timely results. This chain of events enables clinicians to make correct diagnostic and therapeutic decisions using the appropriate level of health care resources.5 Repeated studies have shown that clinicians and patients may not always be receiving optimal laboratory services because of a significant gap in the provision of these services within the profession.6 The gap lies between the increasing number of scientific tests available and the lack of expertise to clinically manage the data emanating from these tests.

Because of this gap, the organizational structure of laboratory services and how these services are provided are changing.7 A perspective of how the doctorate in clinical laboratory science provides a vehicle for this change follows.

BACKGROUND

Traditionally, the laboratory has been recognized as a critical component in the provision of information to clinicians as they assess patient health status. Early on, the pathologist was the singular laboratory professional who provided information to clinicians. More recendy, however, the increasing numbers and sophistication of complex tests fostered the need for development of additional professionals who could augment the pathologist's capability. Now most laboratories of any size have a rich mix of necessary staff at many professional levels.8 These include technicians, technologists, and scientists at a variety of educational levels. The non doctoral clinical laboratory scientists are the most broadly educated in depth within the laboratory fields and are not confined to addressing one specific discipline. These scientists are prepared to rotate through the many scientific testing fields within the laboratory. They have experience and understand testing protocols for blood bank, chemistry, genetics, hematology, immunology, microbiology, molecular diagnostics and virology. They can assure that the correct test is preformed at the right time producing the best information.9 However, their expertise is not always requested and clinicians may look only to the data on paper and not appropriately use their professional interpretive capabilities.