The Role of Medical Laboratory Professionals in Laboratory Stewardship
Creators: Van Spronsen, Amanda D
Publisher: name: University of Alberta Library
Year: 2022

<p>With thousands of available laboratory tests and countless patient variables, clinical decision-making is highly complex. It occurs against a backdrop of time pressures, disjointed communication structures, and a culture that emphasizes certainty. Both over- and under- utilization of laboratory tests occur at unacceptably high rates. Despite considerable research into characterizing misutilization and understanding contributing factors, it remains an issue. There is a progressive trend of involving laboratory medicine professionals in ensuring appropriate ordering and management of laboratory tests. As this perspective becomes more sophisticated, it is increasingly aligned with the concept of stewardship. Stewardship calls for a wholistic, multidisciplinary approach to responsible resource use with an emphasis on securing value for efforts, and has led to new roles, and new challenges, for many healthcare professionals. Stewardship is a relatively recent concept within healthcare, and it is still being defined and integrated.<br>
Behind the scenes in healthcare, there are many professionals that generate and validate the information that is used to make clinical decisions. Medical Laboratory Professionals (MLPs), a term primarily inclusive of Medical Laboratory Technologists (MLTs) and Assistants (MLAs), are a skilled population that collects, processes, and tests biological specimens. MLTs also ensure result quality and communication to the ordering provider. The research presented in this thesis focuses on MLPs. Currently, little is known about how MLPs contribute to existing utilization issues in laboratory testing, or how they impact patient and resource waste in their routine practices. It is also difficult to articulate tangible and practical ways that MLPs can contribute to stewardship interventions and activities, as this deviates from how their work has been historically viewed through the lens of preventing errors and maximizing efficiency. This understanding is vital in highlighting their importance as stakeholders in laboratory stewardship. However, even if new roles and their explicit inclusion in stewardship activities can be justified, the barriers they face may be substantial as they have little visibility and authority outside of the laboratory.<br>
We used a modified Delphi process with a panel of MLPs to identify common practices that contribute to harm and waste. A scoping review expanded on this work to discover what has been published about the impact of MLP practices on inappropriate laboratory utilization, and the roles they can play in stewardship interventions. We administered a Canada-wide cross-sectional survey to assess knowledge, attitudes, and barriers experienced by MLPs as they considered active participation in laboratory stewardship. We used the Theoretical Domains Framework and the Behaviour Change Wheel to characterize survey findings and suggest tailored interventions, respectively. We also asked MLPs about their observations about inappropriate laboratory test ordering to highlight this unexplored perspective.<br>
This research shows that MLPs impact laboratory utilization in both direct and indirect ways during their routine activities, but many practices are absent from published research. Globally, there are staff shortages and burnout, and correspondingly, available research tends to focus on recruitment and retention. This reveals the historical view of the laboratory as a factory of inputs and outputs, with replaceable workers. However, our research shows that these skilled professionals are dedicated to patient care and wise resource use, can offer unique and valuable insights, and want to contribute in meaningful ways to stewardship. Unfortunately, they face environmental, cultural, and social barriers. A shift to laboratory stewardship may bring new roles and new opportunities to MLPs but it must be proactively and intentionally inclusive of all professionals who work in the laboratory. </p>