California Dreamin': Improving Lab Stewardship at UCLA with Dr. Allison Chambliss

Summary:
In this episode of the Plugs podcast, Dr. Mike Astion interviews Dr. Allison Chambliss, Director of Laboratory Stewardship at UCLA Health, which recently won PLUGS Member of the Year. Dr. Chambliss discusses her role in enhancing laboratory stewardship including optimizing reference lab testing, distinguishing experimental testing from medically necessary testing, reducing duplicate orders,
adjusting electronic ordering to ensure better test selection, and more. She discusses the importance of personal communication with clinical colleagues inside and outside her Department of Pathology and Laboratory Medicine, and how to improve the interaction between the lab stewardship committee and
hospital leadership. Dr. Chambliss also shares insights into why Clinical Chemists make excellent Lab Stewards and reflects on the challenges and successes of implementing stewardship initiatives at UCLA.

Links to stewardship work by Dr. Chambliss:

How a Program Manager Aligns Quality Improvement, Laboratory Stewardship, and Equity, Diversity, and Inclusion in Pathology and Laboratory Medicine:

https://www.myadlm.org/cln/articles/2024/julyaugust/how-a-program-manager-aligns-quality-improvement-lab-stewardship-and-dei

Implementation of an automated EMR workflow to facilitate genetic consultation and review of inpatient genetic test requests:

https://www.myadlm.org/cln/articles/2024/septemberoctober/implementation-of-an-automated-emr-workflow

PLUGS (Patient-Centered Laboratory Utilization Guidance Service):
PLUGS Summit:  https://www.schplugs.org/plugs-summit/   
April 2-4, 2025, Bell Harbor Conference Center Seattle, WA

PLUGS Website:
https://www.schplugs.org/

MTS Website
https://medtraining.org/

Chapters

• 0:00 Introduction of Dr. Allison Chambliss, her background, and her role at UCLA.
• 2:06 Dr. Chambliss's start at UCLA, her focus on laboratory stewardship, and her previous roles.
• 4:57 Initial state of the stewardship program at UCLA and the first projects undertaken including physicians choosing their own reference lab without sufficient lab involvement.
• 9:42 Challenges with reference lab selection, physician preferences
• 11:13 Ensuring all samples, including buccal swabs, go through the proper vetting process.
• 13:31 Consolidating reference labs, slowing the growth of new reference labs
• 15:24 Developing and implementing policies and procedures for reference lab workflows.
• 17:02 Making friends, meeting colleagues: Importance of in-person and Zoom meetings for effective laboratory stewardship.
• 19:03 New test requests: distinguishing experimental testing from medically necessary tests
• 23:37 Use of research testing services when tests are not quite ready for clinical use.
• 28:59 Escalation pathways for unresolved issues: the role of the UCLA oversight committee, which is over the Laboratory Stewardship Committee.
• 30:26 Showcasing lab achievements to the Laboratory Stewardship Oversight Committee
• 32:11 Showcasing lab achievements to health system leadership and the impact on patient care.
• 34:22 Governance structure of the lab stewardship committee
• 36:16 Example of a success using research grants to gather evidence for the clinical use of cancer genomic profiling.
• 37:16 Future projects in genetic testing, anatomic pathology collaboration, and tissue send-out testing.
• 39:52 Clinical chemists' role in lab stewardship and their focus on reducing unnecessary testing. Why are chemists a good fit for lab stewardship?
• 42:28 UCLA's recognition as Plugs Member of the Year and the impact on the lab's visibility.
• 44:07 Specific UCLA stewardship projects regarding test selection accuracy and reducing duplicate test ordering.
• 47:49 Approaches to reducing duplicate testing. Improving test selection. Implementing order frequency alerts and hard stops. Handling difficult conversations with providers.
• 55:51 Data battle: challenges in accessing and integrating data for stewardship and financial analysis.
• 1:00:37 Future goals for financial data integration and improving patient satisfaction.
• 1:01:21 Personal insights and rewarding aspects of leading the stewardship program at UCLA.