Why Aligning Laboratory Professionals and Infectious Disease Clinicians Can Deliver Favorable Diagnostics, Treatments

In a traditional medical setting, when we think about the laboratory and diagnostic tests being conducted and we think about the clinic or hospital areas where patients are being cared for, they appear as 2 separate silos with laboratorians and clinicians possibly having very little to no interaction.

However, the development of more sophisticated assays such as rapid diagnostics and PCR testing, combined with concepts like time-to-treat and antimicrobial stewardship have led to the prospective need for the convergence of these 2 groups working together.

“It's such a different world now compared to even 10 years ago,” said Rodney E. Rohde, PhD, SV/SM/MB(ASCP)CM, FACSc, University Distinguished and Regents’ professor and chair for the Medical Laboratory Science Program in the College of Health Professions, Texas State University. “When you look at outcomes on data, you may need to know specific genotypes; you may need to have a full background on oncogenes; you might even have to have a pretty strong background in how to interpret statistical data—and I'm not talking about typical statistical data—I'm talking about the kind of high-level understanding of certain microarray gene expression analysis.”

Antimicrobial Stewardship and the Lab

Of course, the time-to-treat concept, which means getting patients optimal therapy in an efficient, timely manner remains critical, especially when seeing patients who are experiencing difficult-to-treat, gram-negative bacterial infections. Medical complications for these patients can include multidrug resistance combined with a treatment paradigm in which less effective testing is being conducted followed by prescribing practices that include broad-spectrum antibiotics, which do not always align with positive outcomes.

This is where laboratorians can play a key role. And some are advocating for laboratory professionals to be added to antimicrobial stewardship teams, especially as they can, “execute systemic interventions, facilitating appropriate identification of infections (and noninfections) through diagnostic stewardship.”¹

Rohde talks about “being careful with how you work through testing.” He says there are situations where patients come into the emergency room and get a battery of tests that might not be warranted.

“Due to some confusion, or due to maybe not being certain, a dozen tests are ordered that are unnecessary…not only does that waste quality of health care, but it also wastes money. So, it gets to the bottom line of finance around the laboratory and the hospital overall.”

He says one strategy that can help alleviate this waste is the use of the diagnostic management team (DMT). These teams are designed to offer health care professionals assistance in selecting the appropriate diagnostic tests and interpreting results for individual patients. Rohde also says there are education programs that offer doctoral level medical lab scientist degrees, and should go a long way in bridging the knowledge gap.

“If you think about the laboratory and their role in providing that data that informs physicians and pharmacists, it just makes sense that we're on the same team. [This way, we] can discuss whether it's something as simple as what's the best test or assay to utilize to deal with a particular condition or disease,” Rohde said.

“We need to be certain, or as close to certain as we can get, that we're getting an accurate diagnosis, followed by an accurate susceptibility test, so that patients gets the right drug.”

Contagion will be introducing a podcast titled, From Pathogen to Diagnosis: Unraveling the Infectious Disease Mystery, and Rohde will be the host. Look for the podcast's launch in June.


Reference
1. Van Helden S, Ha D. Expanding the Antibiotic Stewardship Team Can Lead to Greater Adoption of Practices. Contagion. February-March 2024, Vol. 09, No. 1. https://www.contagionlive.com/view/expanding-the-antibiotic-stewardship-team-can-lead-to-greater-adoption-of-practices