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WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Final rule from CMS & CDC on PT programs

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On July 11, 2022, CMS and CDC issued a final rule [CMS-3355-F] to update proficiency testing (PT) regulations related to analytes, acceptable performance for laboratories, and administrative processes for proficiency testing programs established under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). The final PT rule considers improvements in accuracy and precision of testing since 1992 and new and emerging technologies.

The effective date of the revisions to PT requirements (§§ 493.2 and 493.801 through 493.959) will be July 11, 2024, two years after the publication date of this final rule in the Federal Register.  The delayed effective date reflects the timeframe PT programs will need to produce or acquire PT samples to meet the revised regulations and incorporate any updates to PT reporting requirements.  In addition, laboratories will need time to prepare and enroll in proficiency testing to meet the new requirements once the samples are available from the PT programs.  However, the regulations related to laboratories performing tests of moderate complexity and high complexity testing that also perform waived testing and proficiency testing enrollment (§§ 493.20 and 493.25) will be effective 30 days (August 10, 2022) after the publication date of this final rule.

WSLH Proficiency Testing will keep you up-to-date in our communications on how we are aligning our PT programs with the final PT rule. If you are not already receiving our monthly newsletter, please sign up here to receive relevant updates and more. You may also follow WSLH Proficiency Testing on LinkedIn to receive information directly to your newsfeed. If you have any questions, please review the fact sheet on the CLIA website, or download the fact sheet directly here. 

You can download the final rule from the Federal Register at: https://www.federalregister.gov/documents/2022/07/11/2022-14513/clinical-laboratory-improvement-amendments-of-1988-clia-proficiency-testing-regulations-related-to.   You may also go to https://www.federalregister.gov/ and search for “CMS-3355-F.”

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

The Search For CE Credits

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Continuing Education for Laboratory Staff

Continuing education instills in us a culture of life-long learning, which is intrinsic to the ever-changing nature of our scientific profession as laboratory professionals. There are a lot of resources available that offer both formal and informal training for a variety of purposes that help us achieve our professional development goals. For many laboratory professionals who work in CLIA certified clinical labs, it is required to complete continuing education credits to maintain certification with the American Society of Clinical Pathologists (ASCP). Cost can be a big factor in our search for credits, especially for those much sought after ASCP P.A.C.E.® certified credits. In this article, we look at some of the available resources by cost, review some pros and cons commonly associated with those resources, and discuss how lab staff can be supported in their efforts to attain continuing education credits.

Gaining Continuing Education Credits through ASCP
If you are one of those Medical Technologists who works to maintain their “MLS (ASCP)” certification every three years, finding reliable and affordable ASCP P.A.C.E.® certified credits can be a challenge. For many of us, we are constantly on the search, asking our clinical lab peers for recommendations on where to find free or low cost courses. Some companies and organizations that offer free, on-demand PACE® certified units include ARUP Laboratories, Beckman Coulter, and CDC Train, the Centers for Disease Control and Prevention’s training system. To search for free, PACE® certified courses in CDC Train, select the option of “Free Courses” under “Common Filters” and “PACE” under “Credit Type” in the Filters side bar on their continuing education course offering page.

Some Pros and Cons to Searching for Free Continuing Education Credits
There are certainly pros and cons to individuals finding their own free Continuing Education Units (CEUs). The availability of courses that are free is certainly one of the primary factors in an individual’s decision to conduct their own search for resources. However, a few of the cons that have encouraged some laboratory professionals to purchase access to online training and course competency tests include “peace-of-mind” and an “easy experience.” For example, many individuals are familiar with ASCP’s continuing education credits; and may choose to pay for their courses. However, if an individual is expected to cover their own costs associated with attaining credits, then monetary investment may be a deciding factor in choosing to “go the free route.” Given such pros and cons in gaining CEUs, laboratory managers are increasingly offering their staff access to CEUs as a job perk, or advantage, to help their employees maintain their certification.

Providing Continuing Education Credits to Staff as a Job Perk
Increasingly, laboratory managers are offering free and easy access to attaining CEUs by purchasing continuing education packages for their staff. With WSLH Proficiency Testing for example, lab management can purchase training and competency bundles at minimal cost with access for up to 30 users. Additional users may be added for a small fee. WSLH Proficiency Testing partners with the University of Washington’s Medical Training Solutions (MTS) to offer online training and competency courses. This low-cost fee helps WSLH PT’s partner instructors assure that the 50+ Continuing Education (CE) coursework is fully customizable and stays in step with emergent learning trends. Full customization means that clinical labs can select their own tests tailored to staff training and individual professional development goals, as well as upload, streamline, and track your documentation. You can also expect high quality multimedia content developed by the University of Washington. Clinical labs can learn more, view products, and request a demo account online on WSLH Proficiency Testing’s website.

Other Preferences for Attaining Continuing Education Credits
Whether or not the CEUs are attained for the primary purpose of maintaining certification, continuing education helps lab staff fulfill their needs and desires to expand their knowledge base and gain leadership skills as they progress in their careers. According to an article published by Lab Manager in 2019, laboratories indicated a variety of preferred training methods beyond the realm of attaining CEUs, such as: monitoring quality trends, conducting annual employee training documentation reviews, taking a class, attending workshops and joining a committee of a professional association. For those who can leave the bench for a day or so, attaining Continuing Education Units (CEUs) at conferences is one of the preferred ways many laboratory professionals receive the CEUs and other forms of training needed to stay current. For those attending conferences, ASCP and AACC will be hosting conferences in-person this year. The 2022 AACC Annual Scientific Meeting and Clinical Lab Expo will be held on July 24-28 in Chicago, Illinois. The 2022 ASCP Annual Meeting and 100th celebration will be held in Chicago, Illinois as well on September 7-9. Continuing education credits will be available for attendees to earn at both of these conferences.

Conclusion Within the healthcare field, technology and testing protocols are ever-changing to meet today’s needs. To help us navigate our increasingly demanding jobs to gain continuing education credits, many more online offerings are available than ever before to bridge the gaps in training access. Having immediate access online and studying at your own pace can help to better balance all of the other necessary tasks in your day-to-day workload. Lab managers are also stepping in to provide easy access to their employees through purchasing continuing education packages that can be customized for their staff’s needs. There are a variety of ways people attain CE credits and other forms of training to help them succeed. Our purposes vary as well, from gaining CE credits for maintaining certification to developing our leadership skills needed to progress in our careers and to transition into leadership roles. However you are working towards professional growth goals, WSLH Proficiency Testing wishes your team the all the best in your pursuits and achievements. 

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up to receive your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Developing ourselves, together through service

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We all know that making connections and continuing our education matters for our development as clinical laboratory professionals. Joining a professional clinical association can be an excellent avenue for boosting our professional development. There are countless benefits for our membership in a professional association. We network and connect with others at conferences hosted by professionals associations, for various reasons. We obtain continuing education credits (CE) at conferences and year-round online. We also take other avenues to educate ourselves and others through training and competency coursework offered by colleges or other providers dedicated to clinical laboratory improvement. Taking advantage of these learning opportunities help us stay proficient in our knowledge, skills, and abilities and helps us stay up-to-date on industry trends. What we may not always take into account is the beneficial return we receive when investing some of our precious time and energy to take on a leadership role or invest in our education. Clinical laboratorians are very busy year-round; how do we justify the time we spend on our professional development initiatives?

Our time and energy is precious. If you are thinking about volunteering, be sure to spend plenty of time reflecting and discerning why you’re taking on a leadership role. Choosing volunteer opportunities that provide a selections process can help determine if the project or committee goals align with your professional development and leadership goals. Regardless of the organization’s process, understanding why you are getting involved can help determine if the service position is relevant to you, and a nourishing environment for your development. Do you want to deepen your professional relationships? Do you want to find ways to increase knowledge-sharing in the industry? Do you want to develop your leadership competencies to help you step into a managerial role? It is important when considering your involvement in a professional association that you feel an enthusiastic “Yes.” If you are feeling neutral about the subject, you may need more time or different questions to determine your interest. If you are not feeling enthusiastic about getting involved, it may mean that other areas of your work and life need your attention and care instead.

Volunteering can significantly impact our learning experience, assuming that our model of leadership development is based primarily on direct, practical experience. Taking on a leadership role with a professional association can therefore be a great way to supplement our current on-the-job experience. Seeking volunteer experiences outside of our industry and in the communities where we live also provides us learning and leadership opportunities that we can carry with us into our careers. There are so many skills that you already use every day at work and at home. What do you want to learn? When seeking volunteer opportunities outside of work, cross out the “can do” skills and focus on the “want-to” skills – the ones that you could see yourself using every day without getting bored. Learning skills outside of work that you will enjoy will help you develop strengths that can impact your career and quality of life in ways that you may not expect. Start out by recognizing the strengths that you are already using in your everyday life. Print out a list of strengths or gifts, circle the skills and abilities that you have and underline the ones that you want. Don’t forget to add your own, if you do not see your particular strength or gift listed!

If you are interested in getting involved in a professional association, maintaining annual membership is the very first step, of course. There are many national and international professional associations with regional and state chapters where you can get involved. Below, you will find a list of the professional associations known for their substantial membership and volunteer opportunities. Click on the hyperlinked text to discover ways to get involved, including governance councils, program committees, and communications teams.

  • AABB: International, not-for-profit association representing individuals and institutions involved in the field of transfusion medicine and cellular therapies. Formerly known as the American Association of Blood Banks.

    Get Involved: AABB Assessor, Mentoring Program, Committee Membership, Junior (Student) Committee Membership, Social Media Collaboration, Leadership-Run for Office, Transfusion Medicine Section, Cellular Therapies Section, AABB Hub (Knowledge Sharing Forum)
  • American Society for Clinical Pathology: Mission is to provide excellence in education, certification, and advocacy on behalf of patients, pathologists, and laboratory professionals across the globe

    Get involved: Public Policy, Career Ambassador 2.0, Patient Champions, Partners for Cancer Diagnosis and Treatment in Africa, Center for Global  Health, Choosing Wisely, Social Media Team, Governance and Member Councils, ASCP Product Development, and BOC Exam Committees
  • CLMA: An international association whose mission is to empower laboratory professionals to achieve excellence in leadership through forward-thinking educational, networking, and advocacy opportunities

    Get Involved: Regarding CLMA Chapters, ASCP is now coordinating the activation of CLMA Chapters in your local area. For 2022, ASCP is waiving the Chapter administrative fee, as CLMA members transition to membership with ASCP.

Getting involved by volunteering, whether with a professional clinical association or with a community organization of your choosing, is a great way to reflect on the strengths you have and to gain the strengths that you want. Giving time to reflect and ask ourselves discerning questions can help us frame our thinking in ways that align our achievement values, professional goals, and leadership development choices. Developing our professional selves with more care and intention helps us become more aware of our strengths and areas of improvement as leaders, helping us joyfully grow our impact for ourselves, each other, and for next generation of clinical laboratory professionals. When we purposefully engage ourselves in community-centered, learning experiences, we open up the doors for more leadership opportunities in our career, and beyond.

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up to receive your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Enhancing The Role of Lab Professionals In Patient Care

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Every year during Medical Laboratory Professionals Week, we are reminded that 70 percent of “today’s medical decisions depend on laboratory test results.” Medical Laboratory Professionals get the results that make an impact on patient care. How lab test results are interpreted is another story that does not often appear in discussions surrounding this statistic. Having more discussions on the interpretations of lab test results is an issue occupying the foremost concern and attention for many laboratory professionals. Such an issue has certainly received more focus with the release of key reports in professional journals and their coverage by industry media within the past 7 years. In response to the Institute of Medicine’s 2015 report Improving Diagnosis in Health Care, everything from doctoral programs to informational, on-the-job handouts, have been produced to address the interpretation of results with the following solution: enhance the role of the clinical laboratorian on the patient care team. Enhancing the role of clinical laboratorians, with the knowledge, skills, and abilities that they bring, is vital in providing the most informed diagnosis. The kind of problem-solving strategies developed to enhance our role demonstrates that education is at the core of the solution, educating ourselves and educating our colleagues outside of the lab. The solutions that manifest always result in a more highly collaborative team of healthcare professionals.

In 2015, the Institute of Medicine released a report, Improving Diagnosis in Health Care, stating that diagnostic errors affect 5% of US adults seeking outpatient care each year, and contribute to approximately 10% of patient deaths and 6% to 17% of hospital adverse events. The report indicated that diagnostic errors cause patient harm, and attributed the statistical occurrences to a gap in communication between physicians and laboratory professionals.  Increasing intentional collaboration is required in order to close the gap, and, ultimately improve the diagnostic process, the report concluded. Not long before the release of this report, the Center for Disease Control and Prevention (CDC)’s Clinical Laboratory Integration into Healthcare Collaborative (CLIHC) conducted a survey to determine the strategies necessary to address this gap in communication. In the survey, family and general internal medicine physicians reported uncertainty in ordering diagnostic tests in 14.7% of patient encounters and 8.3% uncertainty in interpreting results. The survey also found that only 6% of the physicians surveyed consult laboratory professionals at least once a week or daily. In fact, this was the least frequently reported approach to discerning what test to order and how to interpret the test results. Those 6% who did contact laboratory professionals indicated that it was in response to “confusing ordering options on the computer/electronic medical record” or, “when the lab results do not match the patient symptoms.”   It is clear from these statistics that uniting the laboratory with direct patient care is a key component in improving the diagnostic process.

How do we work together to minimize the occurrence of misdiagnosis? Researchers, educators, and others in the field know that the role of the laboratory professional and the knowledge of laboratory science is a vital component on healthcare teams to improve diagnosis. According to the February 2017 issue of Laboratory Medicine, “Some laboratory professionals have become an important member of the clinical team by providing interpretive comments, developing reflex testing programs, and participating on multidisciplinary and diagnostic management teams.” Certainly the creation of the Doctorate in Clinical Laboratory Science (DCLS) program within the past decade has enhanced the role of clinical laboratory scientists on diagnostic management teams (DMTs) today.

Brandy Gunsolus, DCLS, MLS (ASCP)CM, was the first graduate of a DCLS program, graduating from Rutgers University in May 2018. Gunsolus documented her training and her thoughts from the field as a DMT leader in her blog, The Road To DCLS. Here she frequently writes about what many laboratory professionals wonder: what kinds of questions do physicians ask her? She answers that some of those questions may be highly complex, requiring more training on the part of lab staff. However, she says she also answers many questions that “virtually every medical laboratory professional should be able to answer.” Regardless of your official job title in the lab, Gunsolus emphasizes the importance of obtaining CEUs, as they are “essential to us staying current in our profession.” There are excellent online CEUs as well as those offered in-person conferences, like those offered at the ASCLS Joint Annual Meeting. Regarding online resources, WSLH Proficiency Testing, in partnership with the University of Washington’s Medical Training Solutions (MTS), offers customizable online training and competency courses to help labs achieve professional development goals.

“Education is always the key!” Gunsolus says on the importance of including laboratory professionals on healthcare teams. “We must educate ourselves and educate our other healthcare professionals if we are ever going to improve our profession and our patient’s care and safety.”

A brief and compelling look at a few key statistics give us a helpful snapshot of the current climate of laboratory and patient care staff relations. A deeper look at what is being done today will further demonstrate that healthcare teams must work with and include laboratory professionals in order to improve and maintain accurate and reliable patient diagnoses.  Stories of today’s clinical lab trailblazers like provide a unique vantage point regarding what is required to develop mutually-informed, highly collaborative diagnostic teams. Education is required, and takes a two-pronged approach: 1) Educate Others: Include laboratory staff as knowledge-sharers and team members in patient care delivery, and 2) Educate Yourself: Strive to obtain CEUs regularly, and find other professional development opportunities to stay current.  Enhancing the role of the clinical laboratorian in the diagnostic process and on patient care teams will, in turn, greatly impact our visibility to the public as a healthcare professional and as a viable career choice. Laboratory professionals get results each and every day. In honor of your important contributions to healthcare, WSLH Proficiency Testing would like to take this moment to thank each and every one of you for all you do to make a difference.

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up to receive your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Telling Stories: Using Social Media for MLS Recruitment Outreach

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Medical Laboratory Professionals are needed now more than ever. Studies, articles, podcasts, and panel discussions all point to the same primary challenge in the Medical Laboratory profession: clinical laboratories cannot find enough qualified professionals to fill positions. Although staffing shortages have long been a problem, the COVID-19 pandemic has compounded this issue. WSLH Proficiency Testing has also written about the topic of staffing shortages, interviewing instructors and sharing stories from professional associations about student recruitment strategies. These leaders discuss tackling a core problem in recruitment: increasing public awareness of the medical laboratory profession as a viable career choice. More and more, laboratory professionals are emphasizing the potential to build capacity for recruitment through everyone’s ability to leverage social media, at home or at work. As Medical Laboratory Professionals Week approaches in April, we are reminded that each and every one of us can make an impact by sharing our experiences online. 

Public awareness of the medical laboratory profession has increased significantly out of media coverage highlighting lab staffing shortages. Instructors and outreach coordinators emphasize the importance of leveraging this heightened awareness to show the public that the clinical laboratorian plays a vital role in delivering quality healthcare. But how? Through storytelling, says Nadine Fydryszewski, PhD, MS, MLS (ASCP), in a recent AACC article on the need to prepare early-career individuals for clinical laboratory leadership roles. Within this article, she more broadly discusses the importance of building public awareness about the profession as an excellent healthcare career choice.

“Public awareness has increased somewhat due to media covering the shortage of laboratorians, but we also need to tell the story of what we do and how the diagnostic services and patient data we have is critical to quality care,” Fydryszewski said. “Promoting this awareness can contribute to an increasing awareness of medical laboratory science as a career path for those with an interest in science and healthcare.”

Telling our stories as medical laboratory professionals means that we all have an important role to play in attracting students the field. More traditional methods of recruitment, such as career fairs and guest speaking events, are effective for one-on-one connections; but, these methods alone do not provide the broader reach of experience-sharing needed to help individuals come to a decision about their career pursuits. A now decade-old study conducted by Neilson, revealed that 92% of people will trust a recommendation from someone they know while 70% will trust an online recommendation from someone they don’t know. Clearly, the use of social media and other online platforms has grown exponentially. Although this study is specific to advertising, the rise in social media and, in turn, an individual’s presence online strengthens the claim resting at the forefront of this statistic: Sharing our experiences online no matter our age is critical for other individuals to gain the insight and trust needed to make any important decision, especially when financing is factored into those decisions.

Telling our stories on social media is one effective tool in our strategies to attract secondary and older grade school students to the field of Medical Laboratory Science. Marketing studies (and parents alike) illustrate that Gen Z wants deeper interaction with online content, and seeks personalized social media efforts. Professional associations in clinical laboratory science are using social media to let prospective students know what it means to be a clinical laboratorian, and the various career paths that are available. The fact that anyone’s post can influence someone’s career decisions makes social media a very powerful tool to be used with care. Why not be the positive influence in a student’s life by sharing your story? We never know who we are going to impact.

Every medical professional out there can play a part in recruiting students to the profession by sharing their story and resources about the field. This year, Medical Laboratory Professionals Week is April 24-30th, which provides a great opportunity to highlight the role of the clinical laboratorian as a key member of a healthcare team. Take some time to record a 1-2 minute video on your phone about why you do what you do and why it matters to you. Write 50-100 words, and find a picture to accompany your post. Share your story, in whichever form you choose, on your social media using the hashtag #Lab4Life. There are also promotional materials, such as videos and career recruitment toolkits you can share throughout the week on the American Society for Clinical Laboratory Science (ASCLS) webpage for Medical Laboratory Professionals Week. WSLH Proficiency Testing hopes that you celebrate and feel celebrated during Medical Laboratory Professionals Week this year. Thank you for all that you do to impact patient care.

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up to receive your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Steering Clear: Avoiding common PT errors

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Words like “failure” can be scary. In the world of medical laboratory science, the word failure takes on a whole new level of serious, real-life consequences, should failures occur during any kind of testing. Thankfully, when it comes to investigating proficiency testing (PT) failures, there is an abundance of information available online to help clinical laboratories develop corrective and preventative actions to avoid common pt errors.

Pre-examination, examination, and reporting checklists that are generated in root cause analysis, like this handy one from Lablogatory, can serve as a “launch pad” for the development of guidelines to take corrective action. Clinical laboratories use root cause analysis to identify, define, and resolve a core issue, so that resulting errors or failures cease in future proficiency testing efforts. This systematic process of analysis can help us ask the questions that give us the full story of why a failure occurred.

Much like journalists, we laboratory professionals ask “who, what, when, where, and why” questions to help us investigate. In the vein of root-cause analysis, WSLH Proficiency Testing has provided detailed scenarios of common PT failures exemplified throughout the proficiency testing process, from pre-examination to reporting. The review of detailed scenarios in specific proficiency testing programs, which are couched in real-world, empirical evidence can aid clinical lab staff in the development of strategies from investigation to action.

Let’s visit the world of hematology proficiency testing for our first scenario. Since hematology proficiency testing (PT) samples are manufactured material, most PT samples for hematology have to be tested in the quality control (QC) mode instead of patient mode to recover the correct values. In one particular instance, a laboratory did not use the barcode provided on the PT sample. Instead, the lab applied their own barcode which triggered the sample to be tested in patient mode, leading to failures on the differential parameters. The barcode provided by the PT provider would have triggered the sample to be tested in the correct QC mode; and, the lab would have recovered the correct values.

This is a common sample handling error seen in hematology PT and is very avoidable. Many times, labs are instructed to perform remedial action as required by their accreditation agency as a result of this handling error. Sometimes it is helpful to see an example, in order to be able to identify the causes that result in a lab testing in the wrong mode. 

Please see the snippet of a 2020 HemeReg1 report, for example.

Here are some key steps and resources to consider in avoiding this common error:

  • Always read the proficiency testing sample handling instructions that come with your PT kit. In this particular instance, there were specific handling instructions provided for each type of hematology instrument explaining how to test the PT samples in QC mode. If you do not understand the handling instructions, call your PT provider for clarification.
  • Your hematology instrument manufacturer can also be a resource to assist you with testing your PT samples in the mode specified by your PT sample handling instructions.
  • The CLIA Proficiency Testing and PT Referral booklet (pg. 7) provides some helpful guidance explaining that, although you are required to test PT samples like you would patient samples, sometimes PT samples require special treatment.

In the world of Blood Bank (Immunohematology) proficiency testing, the need for labs to seek out remedial testing most often stems from compatibility failures. The Blood Bank Comprehensive program includes a set of five samples (unknowns), plus a donor cell for compatibility testing. When reporting online, it is important to list the compatibility testing method used for each sample. Select if an immediate spin or anti-human globulin (AHG) method was used, so that the type of testing matches the situation and your lab protocol. Some labs use a combination of immediate spin (negative screen) and AHG (positive screen) testing. Others may use AHG for all compatibility testing samples regardless of the screen result. Let’s take a look at these two common errors and helpful hints we can employ to sidestep these failures in the future: 

  • If your lab performs anti-human globulin (AHG) crossmatches, you must perform them on the PT survey when warranted (i.e., when a sample has a positive antibody screen). Do not report an immediate spin crossmatch interpretation as your final result on samples that warrant an AHG crossmatch (has a positive screen) or you risk failure.
  • Labs that routinely perform both immediate spin and AHG testing on all samples should report the serologic interpretation as “Not compatible” if either test is positive.
  • Per CMS, labs using antiglobulin crossmatch methods (automated or manual) that employ a technology only designed to detect incompatibilities due to IgG antibodies, must also use an immediate spin crossmatch to detect incompatibilities due to IgM antibodies (i.e., ABO incompatibilities). 

(Please see the snippet of a 2020 BloodBank3 report, for example.)

Immunohematology proficiency testing samples have a shorter shelf life, as they are manufactured to simulate whole blood. When the PT event closes, these samples expire. Therefore, if a lab needs to troubleshoot a failure, the age or expiration of the samples should be noted with follow-up documentation.  

The oversight of any step, however small, can create major setbacks in proficiency testing. One such oversight commonly made among clinical laboratories is the failure to identify a PT sample—in other words, to treat a proficiency testing sample like a patient sample. Recently, one of our proficiency testing program coordinators received a call from a lab requesting replacement of Blood Gas proficiency testing samples. Upon receiving more context from the lab supervisor, the WSLH PT program coordinator learned that the lab had given the sample set and instructions to the selected Point-Of-Care analyst who was to run proficiency testing for the current event. The analyst ran all five samples without inputting the sample ID into the instrument (i-STAT). They then returned their printouts to the supervisor for submission to WSLH PT. When questioned, they reported that the samples had been run “in order”, but had no proof; so, those results could not be submitted for the event. Subsequently, the supervisor had to call WSLH PT to order (and pay for) a replacement sample set to retest with the sample IDs before they could complete the event.

These detailed, real-world instances that WSLH Proficiency Testing program coordinators have provided aim to assist clinical lab staff in the development of their own strategies, which are situated in root cause analysis. Investigation, planning, and communication with all participating staff can help clinical laboratories get to the root cause of common problems, and to make sure such errors do not happen again. WSLH Proficiency Testing offers a corrective action form online for clinical laboratories to use as a tool or guideline for investigating PT failures. Please refer to our Resource page where you can find this form among other helpful resources for clinical laboratories conducting PT. Utilizing resources and learning from scenarios such as these can aid laboratory professionals in initiating conversations, investigations, and trainings with staff so that common PT failures may be avoided in the future.

This article is featured in our monthly newsletter, The MedLab Retriever. Sign up to receive your digest of clinical lab news, memes, and more:

WSLH PT Blog

Bringing you clinical lab features, news, and updates via the WSLH PT Blog! If you are interested in receiving an email digest of news along with curated staff picks from around the internet, sign up for WSLH PT’s monthly newsletter, The MedLab Retriever.

Feeling Thankful For The Lessons Learned

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5 reasons we’re grateful for those teachable moments of the pandemic 

1. Assuring Laboratory Accuracy
When the pandemic hit, CMS determined that it would be business as usual. Yes, we are thankful for that. It meant more work for us creating different staffing models to do the same work. The reward was knowing that laboratory accuracy was still being measured. We are also thankful for the many lessons learned during this time too.

2. Lessons From The Supply Chain
We learned that the current method of procurement did not stand up to increased demand. In spite of the manufacturer’s ramping up production of needed items, raw materials were unavailable. Even when items could be produced, transportation bottlenecks confounded our ability to get what was needed. Distribution was sporadic; and, some facilities had much and others not enough. There was no system of sharing. We now know that we need better communication as well as a directory of alternate sources. We are thankful that these challenges are being talked about and addressed.

3. Staying Safe At Work
Offices in clinical and other healthcare settings got creative with how they worked, to allow staff and their families to shelter-in-place and quarantine safely. We put our public health values into practice, serving as models for how other workplaces across industries might implement public health measures in response to COVID-19. In particular, WSLH Proficiency Testing was able to shift to a blend of in-office and remote work, so that we could maintain proper social distancing and mitigate the possibility of transmission with less people in the office. We discovered that we could still effectively provide technical troubleshooting and responsive customer service from the safety of our homes. We continue to be grateful for this flexibility.

We learned that biosafety protocols needed review or revision. Clinical laboratories had to discover ways to stay safe, while managing a great influx of tests to process and analyze. From a biosafety standpoint, clinical laboratories had to take pause and assess biosafety challenges, such as how suspected or confirmed SARS-CoV-2 samples should be handled and transported. Clinical labs also had to practice greater care in practicing other testing procedures that are sure not to develop aerosols or droplets in unintentional or undetected ways. We are grateful for the published guidance and resources available for clinical labs to address biosafety challenges.

4. Adapting To Emergent Telecommunication Needs
We also adapted to new telecommunication needs, and to the various tools and platforms that continue to help us stay connected. Across organizations, we are now seeing a successful blending of online teleconferencing and networking platforms with in-person interaction. We hope this hybridization of communication techniques will be furthered in ways to increase inclusivity and promote public health safety in the workplace. We are thankful for the opportunity to learn how to optimize our use of the tools, platforms, and strategies to address emergent workplace needs, both in and beyond the realm of internal and external communications.

5. Everyone Plays A Part In Public Health
Sometimes our lessons learned are difficult to process, especially when we are in the midst of a challenge and might not be able to see how we might move forward. We have and continue to be challenged by disinformation and distrust as the pandemic was politicized from the start. This politicization of the pandemic also, in turn, politicized public health measures that we know work. This has made implementation of a nationwide vaccine program challenging, among other public health measures that we did not foresee would be contested in the political arena. We learned we needed to ramp up our educational outreach and hold media-based organizations accountable for how information about the pandemic was and continues to be disseminated. We learned that we needed to educate the public not just in the face of a pandemic but always in preparation for the inevitable recurrence of new and puzzling infections.

We wish we did not have to learn some of these lessons through the course of a global pandemic; but, such monumental challenges throughout history have been teachable moments for all of us clinical laboratory professionals, the broader scientific community, and champions of public health. The scientific world has pulled together their time, talents, and resources to create new testing platforms, to advance epidemiological tracking, and, through research and diligent work, to develop more than one vaccine to protect healthcare workers and the general population. We are grateful for the individuals and organizations who continue to work at all levels of society to make a changes, at the institutional level, at the individual level, and at the interactional level. We are, most of all, thankful to our customers and laboratories nationwide for not giving up and working together to find a solution. We all have a part to play, and we are grateful for your contributions.

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The Emergence of Coordinated Laboratory Networks

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September 11th and the unique work of a Med Tech in public health

This year marked the 20th anniversary of the September 11th attacks in the United States. Erin Bowles remembers where she was on that day. Erin had just stepped into her supervisor role at Wheaton Franciscan Healthcare about two or three months before. She was tucked away in a room, attending a training led by a few nuns who held administrative positions at the hospital. As she was learning how the whole healthcare system came to be at Wheaton, a few of the nuns got word of what happened and rolled in a TV to watch the fateful events of September 11th, 2001 unfold. Years later, Erin Bowles would become the Wisconsin State Lab of Hygiene’s coordinator for the Wisconsin Clinical Laboratory Network, which was born out of public health’s response to 9/11.

The Wisconsin Clinical Laboratory Network (WCLN) is part of the Wisconsin State Laboratory of Hygiene’s public health response to the federal government’s anticipation of and preparation for bioterrorist attacks following 9/11. The CDC allocated federal funds to public health labs (PHLs) nationwide, indicating that PHLs should get to know the clinical labs in their state and their testing capabilities. Today, the aim of the WCLN encompasses emergency preparedness, disease surveillance, laboratory diagnostics, training and education, and communications. What ultimately drew Erin to working as the assistant WCLN coordinator at the Wisconsin State Laboratory of Hygiene (WSLH) was her passion for education, public health, and microbiology.

As a clinical lab professional, Erin participated in the WSLH’s Virology and TB Networks. She remembers the first outreach to the clinical laboratories when Pete Shult, then director of the Communicable Disease Division (CDD) at WSLH, and Carol Kirk, the original WCLN Coordinator, developed the WCLN.  When the WSLH was hiring an assistant WCLN coordinator, Erin was intrigued. Erin actually heard about the job through a fax that came across her desk; as many of us may remember, this was during a time when fax machines were more commonly used than today.

 “When I saw the announcement, I thought hmmm…,” said Erin with a laugh. “I was really impressed by Carol and Pete and what they were doing at the State Lab. The people here are so passionate about what they do. I love being in public health and thinking about the big picture.”

Now, as the coordinator of the Wisconsin Clinical Laboratory Network, Erin works with more than 130 member clinical laboratories throughout the state, visiting and connecting with labs to provide meaningful guidance and support. This has been especially important during the pandemic. 

Before the COVID-19 pandemic, Erin really enjoyed travelling around the state meeting with WCLN members in their own laboratories to build or maintain relationships and providing educational events, such as Gram stain wet workshops. These wet workshops address the fact that while many of the clinical labs these days are referring most of their microbiology testing to a central laboratory within their healthcare system, or to a reference laboratory, they still need the vital skills required to perform a good quality Gram stain.  It is important to keep practicing these more traditional microbiology methods, even as we work more and more with rapid testing methods. That is why Erin says WSLH Proficiency Testing’s Bioterrorism Preparedness Exercise (WSLH PT Clinical Catalog, page 35) is really important for any clinical laboratory in the United States and beyond to practice.

“It is one of the most important exercises we can provide clinical labs because laboratory professionals do not often get to see these agents, to isolate and identify them. If they are not constantly reminded of certain checkpoints, they forget and exposures occur,” Erin says.

Since microbiology has changed (and for the better) to much more rapid methods, lab professionals may not be sufficiently practiced in some of the more traditional microbiology methods necessary when dealing with some organisms. Exposures are most likely to occur when these checkpoints are missed.

“You may not routinely Gram stain an organism before you put it on a more rapid identification system. In doing this, you may emulsify the organism while working on the open bench. You’ve probably just created an aerosol which would be an exposure,” said Erin. “When you conduct a bioterrorism preparedness exercise, it makes you more aware and reminds you to think more mindfully of those checkpoints.”

Erin adds that WSLH PT’s educational bioterrorism preparedness exercise also helps laboratory professionals become more mindful of the longer 48-to-72 hour slow growth typical of hazardous pathogens, like Brucella sp. or Francisella sp. Most pathogens you encounter typically grow in about 24 hours.

“Slow growth is still a very important indicator that you’ve got a particularly nasty bug,” Erin emphasizes. “It’s a really good exercise that should be practiced a couple of times a year, and it’s a great way to train new employees.”

Whether you are a clinical laboratory in the state of Wisconsin or beyond, the WSLH aims to provide support in a variety of ways. Through her committee work for the Association of Public Health Laboratories (APHL), Erin has been able to work on projects that support clinical labs throughout the United States on topics such as emergency preparedness and biosafety. In 2017, Erin was nationally recognized by APHL as an Emerging Leader. Some of the projects she has worked on are the revision of the American Society for Microbiology (ASM) Sentinel Level Clinical Laboratory Guidelines’, “Definition of Sentinel Clinical Laboratories”, the creation of the APHL “Clinical Laboratory Preparedness and Response Guide”, and the development of various sections within the “Competency Guidelines for Public Health Laboratory Professionals: CDC and the Association of Public Health Laboratories”.

Erin is thankful for the opportunity to work with the sentinel hospitals and clinical laboratories in Wisconsin that are often the first to recognize unusual infections or outbreaks and alert public health officials. Erin thoroughly enjoys her work maintaining and supporting the WCLN and feels fortunate to be allowed to contribute to public health national initiatives through her work with APHL.

Erin Bowles is an amazing leader in public health and WSLH Proficiency Testing is grateful to share an office with her. Erin is a wonderful resource and wealth of knowledge for WSLH PT staff, as we share in our work for educational outreach and laboratory quality.

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Remembering Our Laboratory Leadership

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As you may or may not know, WSLH Proficiency Testing is the only proficiency testing provider that is a part of a public health lab. We are particularly proud of the history of public health excellence that our colleagues at the Wisconsin State Laboratory of Hygiene (WSLH) have advanced since our inception as a clinical proficiency testing provider in 1966. In light of a colleague’s recent passing, we wanted to highlight his contributions to immunology and to public health overall. Rjurik (Rik) Golubjatnikov, PhD, emeritus chief immunologist at the Wisconsin State Laboratory of Hygiene (WSLH) and emeritus University of Wisconsin (UW) professor of preventive medicine, passed away in late July 2021 in Madison, Wisconsin. Dr. Rik was the WSLH’s Chief Immunologist from 1967 until his retirement in the late 1990s. Dr. Stan Inhorn, emeritus director and medical director of the Wisconsin State Laboratory of Hygiene and emeritus UW professor of preventive medicine wrote this obituary for Dr. Rik. Telling stories about each other and about our work as medical laboratory professionals and public health leaders remind us why we do the work that we do and keep us feeling connected as a community. Here is an excerpt of that obituary:

Rjurik (Rik) Golubjatnikov, PhD Rik Golubjatnikov was born on June 19, 1931 on Muhu island, one of many islands that lie offshore of Estonia in the Baltic Sea. His father was the island’s doctor, health official, and coroner. His mother was a singer and expert in national dresses and textiles. Because of its location in Europe, Estonia was affected by cultural and political events in Scandinavia, Russia, Germany, and other European countries. Consequently, Rik became proficient in speaking Estonian, German, Russian, and later Spanish.

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Rik’s life changed in 1939 when Germany and Russia signed the Molotov-Ribbentrop Pact that gave Estonia and Finland to the Soviet Union. […] On July 1, 1941, a mass deportation resulted in Rik’s father being sent to a gulag in Russia where he perished within a year. Rik, his older brother, and their mother were sent to a camp in northern Estonia where they worked in the fields, slept on the floor, and endured many hardships.

In August, Germany violated their pact with Russia and invaded the Baltic countries. Rik’s family was allowed to return to their home. Life under the German occupation was difficult. Their attempt to sail to Sweden in a small boat was unsuccessful, resulting in the family being sent to a labor camp near Frankfurt where Rik contracted tuberculosis.

The nightmare ended in 1945 when the U.S. Army swept into Germany. A camp for Estonian displaced persons was established in Geislingen, a town in Southern Germany, under the direction of UNRRA. Their home for the next four years was a small room in a duplex house. A school was started with enough teachers but little in the way of supplies. The curriculum included English, and Rik’s proficiency in English was bolstered by writing to pen pals in the U.S. Boy Scout leaders from England and the U.S. came to the camp and started a troop. At a Jamboree in France, Rik’s brother met a Scoutmaster from Illinois who found a sponsor for the family in Springfield, Illinois. In August, 1949 they sailed to the U.S. and to their new home, a large estate near Springfield. They bonded with the lady of the house and her two children, performing household jobs in exchange for their board.

Rik passed the high school equivalency exam and obtained a scholarship to Millikin University in Decatur, IL. […] He received his Ph.D. in Epidemiologic Studies [at the School of Public Health at the University of Michigan] in 1964 and took a job at SUNY in Buffalo as an Assistant Clinical Professor in the Department of Preventive Medicine. His research was in a virus vaccine evaluation project, which required that he build a virology and serology laboratory for the project.

In 1967, Rik accepted an offer to start a Section of Immunology at the Wisconsin State Laboratory of Hygiene (WSLH) on the University of Wisconsin campus. […] Rik was a leader in designing programs for control of syphilis and gonorrhea, and later other sexually transmitted infections. He helped design the creation of serum banks, which were crucial in documenting epidemics of infectious diseases. […]

Rik’s research interests extended to Central and South America, where he carried out serum surveys to determine the prevalence of various infectious diseases. When the AIDS epidemic started in the 1980s, he carried out serologic studies in Wisconsin and several countries in the Americas. Other studies included tests for infectious mononucleosis, HIV, maternally transmitted agents, enzyme tests for streptococcal infections and tests for other respiratory infections. […]

Rik had many friends in Madison and in the countries where he traveled. He is survived by his  nephews and their families.

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WSLH Proficiency Testing Staff Spotlights

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As part of a public health lab, we put people first. That includes the people who help make the programs and the day-to-day operations at WSLH Proficiency Testing run smoothly. We could not do what we do for laboratory quality without our wonderful and dedicated team. We would like to take this moment to recognize Danielle Kratzke and Rhonda Stauske, two amazing Medical Technologists who bring a lot of knowledge, skills, and camaraderie with them to the office. Stay tuned for more staff spotlights next month!

Meet Danielle Kratzke! Danielle is a Medical Technologist and Proficiency Testing Coordinator in Chemistry and Special Chemistry programs for WSLH Proficiency Testing. Danielle grew up in Peshtigo, WI and moved to Madison, WI for college at the University of Wisconsin-Madison. Before coming to WSLH PT, she worked as a Medical Technologist in the QC Lab at the American Red Cross and in the Clinical Pathology Lab at Covance in Madison, Wisconsin.

Besides her great coworkers, Danielle’s favorite thing about working with WSLH PT is the enjoyment of analyzing the data and seeing labs perform well. “It is great to see an analyte with 100% consensus, low CV%, and all labs getting 100%,” said Danielle. When she’s not at work, Danielle enjoys playing with her cats Luna (aka Little Girl) and Felis Catus (aka Felis, Fee Fee, Buddy), hiking nature trails, relaxing with friends with a cold brew, trying new restaurants, playing board games, going to the movies, and attending neighborhood festivals. This summer, Danielle is looking forward to attending some of those neighborhood festivals, concerts, and movies again!

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Meet Rhonda Stauske! Rhonda is a Medical Technologist and Proficiency Testing Coordinator for WSLH Proficiency Testing. Thoughtful and generous, Rhonda’s golden rule is treat others how you want to be treated. That’s why, she says, her favorite thing about working at WSLH PT is the people. “Best coworkers ever,” Rhonda says. Before coming to WSLH PT, Rhonda worked as a Medical Technologist at a clinic in Madison, WI.

At WSLH PT, Rhonda coordinates PT events including Immunology, Blood Lead, Legionella, and International Shipments. When she’s not at work, she enjoys spending time with her husband, who is the funniest person she has ever met, and her teenage son, who is in high school and now learning how to drive. She also loves to read, garden, travel, and go on walks. If Rhonda had to eat one thing for the rest of her life, it would probably be tacos! Rhonda has lived in the Madison, Wisconsin area her entire life. She’s looking forward to a lot of things in her near future, including her trip to Greece later on this summer!