Using the EPIDEM Model of Quality Improvement to Increase Value of BCR-ABL1 Tests

Am J Clin Pathol. 2019 Jan 1;151(1):68-74. doi: 10.1093/ajcp/aqy089.

Abstract

Objectives: As pathologists and laboratorians, we can enhance patient care by promoting the appropriate ordering of diagnostic tests. Our goal was to improve the ordering of BCR-ABL1 tests by using the EPIDEM model of quality improvement.

Methods: We applied the EPIDEM model, which emphasizes understanding local context, culture, and resources, to explore inappropriate BCR-ABL1 ordering, promote and implement a new reflexive testing strategy in-house, document and evaluate effectiveness, and make stepwise modifications.

Results: Multiple quality improvement interventions correlated with cost savings and decreased total errors and incorrect orders for both BCR-ABL1 major and minor positive patients. Furthermore, our laboratory built stronger collaborative relationships with colleagues within and outside of pathology.

Conclusions: Our molecular pathology laboratory successfully used the EPIDEM model of quality improvement to improve the ordering of BCR-ABL1 tests and promote better patient care by focusing on educational efforts and modification of laboratory workflow.

MeSH terms

  • Cost Savings
  • Diagnostic Errors / prevention & control
  • Diagnostic Tests, Routine / economics
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Electronic Health Records
  • Fusion Proteins, bcr-abl / genetics*
  • Humans
  • Laboratories
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / diagnosis*
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / genetics
  • Models, Statistical
  • Pathology, Molecular / economics
  • Pathology, Molecular / standards*
  • Patient Safety
  • Quality Improvement*
  • Software
  • Workflow

Substances

  • BCR-ABL1 fusion protein, human
  • Fusion Proteins, bcr-abl