All Case Examples

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Partners HealthCare is finding success in fully integrating its 11 hospitals by following a path of collaborative problem solving that encourages creative thinking for more economical, efficient, patient-centered care. As a part of the Partners network, Newton-Wellesley Hospital’s pathologists share the laboratory team’s ideas at a variety of medical staff meetings. Michael J. Misialek, MD, FCAP, recounts how the laboratory billing staff was integral in reducing waste, cost, and unnecessary testing.

Cleveland Clinic’s Laboratory Stewardship Committee uses a multidisciplinary team approach that draws upon resources and personnel within the hospital information system, laboratory, and clinical staff to improve patient care. Laboratory test utilization initiatives introduced since 2011 have saved the Cleveland Clinic $5.0 million—the cost avoidance in 2017 alone was more than $835,000. This teamwork approach has brought best practices and systemwide changes to bridge the connection between systems that work, patient safety, and improved patient care.

Using metrics to pivot for change, Amanda E. Haynes, DO, FCAP, collaborated with her team to motivate a system-wide effort that saved more than $1 million in blood acquisition costs across Pennsylvania’s Geisinger Health System.

Identification and treatment of vitamin D deficiency is important for musculoskeletal and extra-skeletal health. For serum vitamin D testing of at-risk populations, there are well-defined clinical indications, including osteoporosis, malabsorption, fracture, limited effective sun exposure, obesity, and institutionalized individuals, among others. In these individuals it is appropriate to measure vitamin D to determine the dose of oral vitamin D supplementation to reach target levels. Repeat testing to ensure replenishment is also warranted.

Leaders in pathology education scramble to design curricula that keep pace with the science of medicine without losing sight of either their trainees’ need for hands-on experience or the practical constraints that limit the flexibility of their clinical and administrative partners. One program director offers a snapshot of not-unwelcome challenges pathologists in training and their educators encounter. Can reframing pathology training benefit patients, colleagues, and administrators?

Because standards and practices—second nature to pathologists—are so readily scaled up and transferred to other domains, pathologists are well prepared to take on broad, interdisciplinary roles. The career path of Stephanie Mayfield Gibson, MD, FCAP, into population health illustrates how pathologists’ roles are evolving and are poised to accelerate.

Finding ways to monitor and manage the constant stream of information that may or may not be actionable to clinicians is a prime focus for Cordelia E. Sever, MD, FCAP, and her team at Pathology Associates of Albuquerque. They are coming to grips with the need for more refined, targeted, and dynamic information management that benefits interspecialty collaboration—and the patient.

Ebola Virus Disease put the biocontainment facility at Emory University Hospital to the test and put an emphasis on team integration and safety procedures.

The Outpatient Cytopathology Center in Johnson City, Tennessee, grew into a thriving business, attributed in large part to its concentrated focus on pathologist-led services that integrate clinical care and prompt reporting of test results. CAP member Susan D. Rollins, MD, FCAP, and her two partners deliver a distinct value to patients and referring physicians alike in which FNA and surgical biopsies are among the services they perform and interpret.

As a systems-oriented physician, Alexis Byrne Carter, MD, FCAP, uses her pathologist’s curiosity and clinician’s interest in how people think as she observes, evaluates, and negotiates on behalf of patients to remove ambiguity in systems and processes.

Type 2 diabetes mellitus (T2DM) is a dangerous disease out of control: US Centers for Disease Control and Prevention (CDC) data for 2007–2010 showed that 47.5% of adults with diabetes had average blood glucose (HbA1c) levels exceeding the American Diabetes Association (ADA) target of 7.0%. The ADA estimates that T2DM accounts for $1 of every $5 spent on health care in the United States, and the CDC puts diabetes prevalence at 8% of the US population. A December 2014 ADA report pointed to a 74% increase in the cost of prediabetes and an 82% increase in the cost of undiagnosed diabetes between 2007 and 2012.

When Liron Pantanowitz, MD, FCAP, is thinking about launching a project, he asks himself three questions: (1) Is it the right thing to do? (2) Is it feasible? (3) Do others share his vision? If all three are a yes, it's a go.

The most persuasive arguments for the value of pathology will be direct, concrete, and evidence based.

Many physicians worry about whether patients with chronic pain take their medication incorrectly or in combination with other substances, but few have the toxicology expertise required to know for sure. Physicians on staff at Tufts Medical Center are fortunate in this regard. Hospital guidelines to address ambulatory management of patients with chronic pain include instructions for follow-up that feature a number to call for further advice. That number connects them to the telephone of Barbarajean Magnani, PhD, MD, FCAP, chair and pathologist-in-chief in Tuft's Department of Pathology and Laboratory Medicine. Dr. Magnani gets a lot of calls.

Pathologists and other laboratory professionals engineer systems-oriented solutions that benefit large populations. Many positive process changes involve small steps that draw little attention. Screening all new admissions for Methicillin-resistant Staphylococcus aureus (MRSA), for example, may have sounded like a bother until clinical experience demonstrated the time and money saved downstream in hospital operations.

Montefiore MedicalCenter (Montefiore) in the Bronx, New York, serves one of the poorest and most diverse urban communities in the United States. Each year, Montefiore logs 93,000 admissions and 2.6 million ambulatory visits in nearly 100 networked locations. Medicaid and Medicare accounted for 80% of patient revenue in 2011.

Whether she plans to reframe a clinical colleague's thinking about blood product utilization or enable a legislator to see that high-quality laboratory services are fundamental to population health, Kathryn T. Knight, MD, FCAP, knows that successful persuasion is nearly as much about the messaging as the message.

Practice guidelines are translational research writ large: tools that gain value as they enable evidence-based care. When more patients get better quicker because standardized procedures produce more precise and useful test results, everybody wins.

In 2008, the University of Rochester Medical Center (URMC) Perioperative Safety Committee was having concerns about specimen label accuracy. David G. Hicks, MD, FCAP, a member of the committee and director of surgical pathology, volunteered to investigate.

James M. Crawford, MD, PhD, FCAP, came to North Shore-LIJ (NSLIJ) Health System in New York in 2009, when coordinated care was just picking up steam. He joined a forward-looking health system intent upon building a model-integrated health care network in a service area of 7 million patients.

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