Tiers of Service framework and approach
The Maternal/Fetal, Neonatal and Pediatrics: Laboratory Medicine, Pathology & Transfusion Medicine Services module describes the services provided by publicly-funded, hospital-based laboratories to support the clinical care of women (reproductive care), neonates, and children in British Columbia (BC). The intention of the tiers of service is to align laboratory, pathology and transfusion medicine services with the clinical needs of the majority of patients who access the site. Trauma, emergency, pediatric medicine, oncology, and maternity volumes are key variables in the level of pathology service required, due to the frequency of requests. In considering how to develop the Tiers of Service approach, we studied the published literature about system planning and reviewed the work of other jurisdictions including the UK, Australia and others. The module was developed by an interdisciplinary working group comprised of laboratory physicians, clinical scientists, and operational leaders from each of BC's Health Authorities, a pediatrician, and representatives from Child Health BC and Perinatal Services BC.
There are 6 tiers in the clinical diagnostic tiers of service for Laboratory Medicine, Pathology & Transfusion Medicine services, labelled Tiers A - F, that align with Tiers 1-6 of the clinical modules (This work has already been done in BC for medicine, surgery, and emergency). Tier A offers laboratory and/or pathology services which support the care of women in and around low risk pregnancies, & healthy infants & children. These laboratories are in primary care or community health centres. Tier F offers in-depth, sub-specialized laboratory and pathology services which support the care of women, prenatal and perinatal, infants, & children with the most acute/complex conditions. Each one of these tiers is important and each tier has unique roles in serving women, neonates, and children. The system as a whole functions best when all the Tiers know and accomplish their responsibilities and fulfill their requirements.
The final version of the module was submitted to BC's Agency for Pathology and Laboratory Medicine Regional Leadership Committee, the Child Health BC Steering Committee, and the Perinatal Services BC Steering Committee for their acceptance.
Once a module is finalized and accepted by the key partners in the province, a self-assessment is completed. The Tiers of Service self-assessment is an opportunity for stakeholders to assess their current state and identify strengths and opportunities with respect to those outlined in the module.
In June 2018, Child Health BC has supported the data collection for the self-assessment. Results from the data collection are being analyzed and validated. Reports will be generated to the local site, health authority, and province to be utilized for service planning and quality improvement.
Together we can achieve our goal of a strong system of service delivery for maternal/fetal, neonatal and pediatric laboratory services.