Clinical pathways (care maps) (used for conditions, diseases, and procedures for which the patient outcome is very predictable)
2. Clinical guidelines (used for care situations in which the outcome may have a few more variables)
3. Clinical algorithms (used for patient outcome situations in which more options may be required)
4. Case management (generally used for very complex cases, for which it is very difficult to establish a predetermined pathway; the patient may have multiple medical problems and/or complications)
Many personnel issues will continue to be relevant and important. Particular emphasis will probably include (i) the use of unlicensed individuals in relationship to CLIA ’88 and various states developing, implementing, and revising personnel regulations; (ii) cross-training and the use of multiskilled laboratory personnel; (iii) tremendous flexibility in covering fluctuations in workload; (iv) expansion of the use of multidisciplinary teams; (v) continued emphasis on horizontal rather than vertical management structures; and (vi) development and utilization of personnel competency assessment programs (now mandated by regulations).
The aging of the population will have a profound effect on many health care issues. Laboratory testing and monitoring will be no exception. Patient access, alternative-site testing, and clinical decision support options will play a large role in helping manage this expanding population.
Not only do we have to deal with expanding diseases and conditions in the elderly, but also we now are faced with some serious problems related to infectious-disease threats. There is explosive population growth worldwide with expanding poverty and urban migration; international travel is increasing; and technology is rapidly changing. All of these factors affect our risk of exposure to the infectious agents in our environment. In recent years, our antimicrobial drugs have become less effective against many infectious agents, and experts in infectious diseases are concerned about the possibility of a “postantibiotic era.” As a result, our ability to detect, contain, and prevent emerging infectious diseases is in jeopardy.
In the wake of the events of September 11, 2001, credible threats of terrorism that include the potential use of nuclear, chemical, and biological agents have had significant impacts on the funding and costs of providing laboratory services. The identification of clinical cases and environmental contamination caused by deliberate dissemination of Bacillus anthracis through the mail system during the early part of 2002 emphasized this lesson for a number of microbiology laboratories. These events and the fear of additional terroristic use of other infectious agents have not only alarmed the public, the government, and the medical and microbiological community but also focused attention on technical capabilities, biologic safety infrastructure, and staff preparation (71, 72).
Unfunded programs will impact training costs, acquisition and deployment of equipment, facility modification, and other unfunded mandates, such as the CDC-issued rules (August 2002) requiring all laboratories to report to the government whether they are in possession of “select agents” that could be used in a bioterrorist attack. The rule is available at http://www.selectagents.gov/regulations.html (accessed 5/26/2015) (4). However, increased federal concerns about laboratory preparedness have generated some increased funding for specific areas of the laboratory; it is more likely that in the event of actual or suspected biological attacks, the impact on the laboratory will be to significantly increase laboratory services. These increases will focus on unusual/potentially dangerous diagnostic challenges and on the potential massive increase in demand for routine laboratory services required for the care of large numbers of acutely ill patients.
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