Document: Advanced Practice: Doctorate in Clinical Laboratory Science
Classification: Position Paper
Date: July 2005
Status: Approved by the ASCLS House of Delegates, July 2005
The idea of interdisciplinary health care teams to provide more effective medical care for patients has been promoted for decades. Unfortunately, efforts to include laboratory practitioners in this goal have fallen short. One reason for failure has been the lack of an appropriately educated laboratory professional to contribute to interdisciplinary health care teams. In designing educational models to develop such team members, it is important to prepare each team member at the proper knowledge level to meet the needs of the health care team and to gain the respect of other team members. For Clinical Laboratory Science this level should be an advanced practice curriculum culminating in a professional doctorate.
Clinical laboratory services provide approximately 60- 70% of the objective information used in clinical decision-making.1 In 1999, the Institute of Medicine reported that an estimated 98,000 Americans die each year from preventable errors.2 The American Society for Clinical Laboratory Science supports IOM's recommendation for healthcare professional collaboration and promotion of effective team functioning to raise awareness in preventing laboratory errors.2,3 Inclusion of the clinical laboratory practitioner in the interdisciplinary team approach would have a positive impact on patient outcomes. It would result in cost savings to the healthcare system by providing valuable and reliable clinical based knowledge regarding laboratory testing that fosters accurate and timely diagnoses. This further supports the IOM's report suggesting that improved access to accurate and timely information is a way to prevent errors and improve patient safety.2 The advanced practice clinical laboratory practitioner may increase efficiency, facilitate patient management outcomes, and improve access to accurate laboratory information by participating directly in patient care decisions.
Clinical laboratory scientists have extensive knowledge regarding laboratory tests and data and, with advanced training, may help clinicians choose appropriate laboratory studies based on physiological and clinical situations. Their background in understanding concepts such as false positives/negatives, interferences, and limits of detection can improve decisions made regarding patient care. This advanced practitioner level would be in a unique position to improve patient outcomes while developing and strengthening collaborative relationships among laboratory services and other healthcare providers. The types of services that the advanced practitioner could provide include preliminary test selection and interpretation, recommendation and interpretation of additional testing, point of care testing, and patient education and consultation. As a direct care team member, this practitioner will serve as a liaison between nursing units, healthcare providers and the laboratory to ensure quality and cost-effective laboratory services. Other roles may include education for diabetic patients on the use of home testing procedures or consulting with patients on the results of tests ordered through direct access testing.
ASCLS views the Doctorate in Clinical Laboratory Science as part of a career ladder. In July 2004 the ASCLS House of Delegates accepted a model career ladder for the profession.4 The Advanced Practice Scientist III level represents the professional doctorate degree in Clinical Laboratory Science. At this level of practice, the CLS is expected to serve in consultant roles, perform patient assessments to determine clinical status of the patient, and manage patient laboratory data as part of the health care team.
Potential barriers to the development of this new role of the Clinical Laboratory Scientist are expected. Education regarding role definition and scope of practice will be essential for smooth transition into the patient care setting. Future pilot projects will most likely be needed to help define role expectations.
Issues that must be addressed once pilot studies are complete include specific job description with salary expectations, physician collaboration, certification/licensure, acceptance by other health-care providers, cost-benefit analysis, professional liability and healthcare reimbursement. In today's healthcare setting, cost justification and healthcare reimbursement regulations are crucial. The most probable obstacle will be healthcare reimbursement. New healthcare policies will need to be developed through appropriate governmental agencies
ASCLS supports the development and implementation of a professional Doctorate of Clinical Laboratory Science degree in institutions of higher learning.
Presently, the only science oriented post-baccalaureate educational options for the clinical laboratory scientist are in the research track and include the Master's Degree and PhD. The professional doctorate would not be viewed as an entry level for the profession but instead will provide an additional level of education to afford new opportunities for the clinical laboratory scientist. ASCLS recommends that the professional and the degree be designated a Doctorate in Clinical Laboratory Science (DCLS).
ASCLS supports the idea of designing a common education model for this professional degree and implementing programs in a collaborative manner.
A basic curriculum should be designed to include the core courses, basic science courses, and clinical courses that would provide the knowledge, clinical skills and interpersonal skills needed for competency at this level of practice. Pilot programs for the professional doctorate should be implemented to ensure that this new role of practitioners is properly introduced into the health care arena. Additionally, these pilot programs can establish the overall effectiveness of the education model. Data regarding clinical outcomes and financial impact of patient care involving the advanced practice clinical laboratory practitioner will be essential to help support the new role. As demand for these programs will be small at the outset, it may be difficult for any single institution to provide an entire curriculum, thus impeding the ability of institutions to justify the development of such programs. Consortia or other collaborative models that rely on distance delivery options and emphasizing the relative strengths of the participating institutions may lead to swifter implementation of these programs.
ASCLS supports and encourages development of interdisciplinary healthcare teams that include the professional doctorate prepared clinical laboratory scientist.
The clinical laboratory practitioner can be a valuable member of the health care team. After completing the Doctorate of Clinical Laboratory Science, the practitioner will collaborate with physicians and other healthcare providers in the diagnosis and treatment of patients by ordering, performing, correlating and interpreting laboratory tests as well as monitoring patient outcomes.
ASCLS encourages the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) to develop accreditation standards for DCLS level programs.
As part of these standards, it would be expected that, within 10 years following the initiation of the first educational program in the country, an accreditation requirement for these programs would be to have on staff at least one faculty member who is DCLS prepared and certified.
ASCLS believes that practitioners at the DCLS level should hold active certification and/or licensure.
Individuals at the DCLS level must be certified through independent agencies whose structure parallels those of the physical therapy, pharmacy and nursing professions. Similar state licensing boards should be created in those states with appropriate licensure laws.