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Free P.A.C.E. CE Webinar on Proficiency Testing

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Watch our webinar for an opportunity to receive a free CE credit upon completion

So, you’ve failed a proficiency test–now what? While it may be difficult to move to a course of action in the moment, preparing for this scenario ahead of time can give clinical laboratory professionals the tools we need to do so, with more ease. WSLH Proficiency Testing is offering you access to a new ASCLS P.A.C.E. certified webinar, developed in partnership with the Wisconsin Clinical Laboratory Network (WCLN). 

This webinar aims to help participants know how to follow-up, prepare, and prevent common scenarios in clinical proficiency testing. While this webinar was originally created for the WCLN, WSLH Proficiency Testing is now offering you the same educational opportunity. We hope that this webinar will provide you with useful information to share with your staff. You may access and progress through the webinar at your own pace. Upon completion, you will have an opportunity to earn a free CE credit.

At the end of this webinar, participants will be able to:

  1.  Identify clinical proficiency testing best practice
  2.  Increase knowledge of labs’ experiences with conducting proficiency testing
  3. Explain what a laboratory must do when they have a proficiency testing failure

Participants will be able to take away key insights from WSLH Proficiency Testing’s technical coordinators serving on the webinar panel: Ann Hennings, MLS (ASCP) and Rhonda Stauske, MLS (ASCP). This P.A.C.E. certified webinar is graded at an intermediate level, meaning the educational content serves mostly as a refresher course with some basic knowledge of proficiency testing required for a participant to successfully complete the program objectives.

Oh no! I’ve failed a proficiency test–Now what? webinar
Please click the following link to access the free, archived P.A.C.E certified webinar
for an opportunity to earn a C.E. credit upon completion: https://slhstream2.ad.slh.wisc.edu/Mediasite/Play/72ee607528264590a210cf03037e54241d

Note:
You will need to login (or register for free, if you are not a member) on the ASCLS CE Organizer webpage in order to claim your free CE credit. Once logged in, please click the Claim Credit tab in the top navigation bar. Then click on the ASCLS State and Regional tab to locate ASLCS-Wisconsin. You will find the webinar listed by date for November 2nd, 2022. Check the box to the right to select this credit. You will be prompted to enter in the information needed from there. 

free CE credit image

Over the past few months, our technical coordinators at WSLH Proficiency Testing collaborated with other experts at the Wisconsin State Lab of Hygiene (WSLH) to support an educational training opportunity, as part of a series of educational webinars offered by and for a network of clinical labs in Wisconsin. This network of clinical labs is known as the Wisconsin Clinical Laboratory Network (WCLN), which is coordinated by Erin Bowles, MLS (ASCP), who we featured in an article last year about her unique role as a medical laboratory professional in providing outreach and support to clinical labs throughout the State of Wisconsin. We also featured the history of the WCLN, which offers outreach and resources to support emergency preparedness, disease surveillance, laboratory diagnostics, training and education, and communications. WSLH Proficiency Testing collaborates with other entities at WSLH to add value to the labs we serve. From our most recent collaboration with the WCLN, we hope you find this webinar to be a helpful resource for your staff.

As part of WSLH Proficiency Testing’s mission to improve laboratory quality for all, providing educational opportunities to promote career competency and achieve leadership development goals are very important to us in our unique role as a PT provider that is backed by a national public health lab and a Big Ten University. To learn more about other resources we offer labs, please view our resources page on our website at: wslhpt.org/resources. If you are interested in online training and competency courses to offer to your entire staff as a benefit for their professional development, please keep in mind WSLH PT’s comprehensive offerings of online training and competency MLS courses.

If you have any questions about the content we cover in this free PACE certified webinar, please do not hesitate to reach out to WSLH Proficiency Testing: ptservice@slh.wisc.edu. Our team is happy to help yours, anytime. Supporting the quality of your lab is our mission.

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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.

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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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.

Occupational Safety From A Public Health Standpoint

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While much has changed in our world since the start of the pandemic, there are some positive developments and plenty of lessons learned that will help us as we move toward the future. Certainly, lessons were learned in the world of laboratory safety. Here at the Wisconsin State Lab of Hygiene, which is home to WSLH Proficiency Testing, we are constantly learning about adaptation during the COVID-19 pandemic from our colleagues and coworkers at the Wisconsin Occupational Health Laboratory Division. In particular, their free consultation program WisCon has expanded their services from assisting small businesses with chemical, noise, and air monitoring, to now providing COVID-19 consultations and respirator fit test kits to facilities, including skilled nursing facilities. As North American Occupational Safety and Health Week (May 2-8) approaches, WSLH Proficiency Testing (PT) wants to raise awareness of the importance of preventing injuries and illnesses at work. Regardless of our sector or industry of employment, WSLH PT hopes that individuals and organizations take advantage of the resources that maybe available to them to ensure a safe and healthy work environment.

Ernie Stracener (right), consultation program manager, and Dan Trocke (left), safety consultant with the Wisconsin State Laboratory of Hygiene at the University of Wisconsin–Madison, pack PPE supplies into boxes at a warehouse in Madison. Photo by Bryce Richter

Ernie Stracener from the Wisconsin State Lab of Hygiene gets to see how everything is made, from foundries pouring molten steel to veterinarian clinics conducting testing for your pets. It’s a wonderful side-perk in his efforts to help small businesses maintain safe working conditions. Ernie Stracener is the Consultation Program Manager for the Wisconsin State Laboratory of Hygiene’s WisCon project, which provides free industrial hygiene inspections and occupational safety consultations for small businesses across the state of Wisconsin. 

The WisCon project is the largest consultation agency in the state of Wisconsin, helping the private sector have on-site and virtual consultations regarding any potential work-related hazards, including noise level testing, gas monitoring and air quality sampling.

Every week, consultants from WisCon travel the state conducting on-site inspections and providing safety consultations to small businesses with under 250 employees. That adds up to a little over 450 on-site consultations with approximately 350 businesses every year. The WisCon project has been in existence for 40 plus years, and has had to get creative like so many others in response to COVID-19 in how they provide their services.

 Since the pandemic, WisCon has been providing consultations on COVID-related activities. Starting in July of last year, the Wisconsin State Lab of Hygiene partnered with the Wisconsin Department of Health Service (WDHS) to expand lab capacity in SARS-CoV-2 testing for the state. As part of that partnership, WisCon received funding to provide COVID-19 consulting, create and distribute respiratory fit tests for N-95 masks and other respirators, and develop decontamination methods for single-use PPE for small businesses and medical facilities. Such services that WisCon provides, Ernie adds, are very unique to the state of Wisconsin. “It may be happening from other sources, but this is a product of a very specific request from the Wisconsin Department of Health Services. We were glad we could be plugged into the COVID relief efforts in this way. It’s been rewarding,” said Stacener.

As WisCon continues to provide and expand occupational health and safety services to small businesses and facilities in the private sector within Wisconsin, there are other sectors that could benefit from WisCon’s free consultations, including the public sector. However, public sector employees in Wisconsin right now can take advantage of COVID-related consultations from WisCon.  Many more opportunities to expand service in workplace safety and industrial hygiene in all sectors of employment may arise as individuals become aware of the vital resource that WisCon provides. Raising awareness as part of North American Occupational Safety and Health Week presents an excellent opportunity to focus, reinforce, and strengthen commitment to occupational safety and health. For clinical laboratories in particular, WSLH Proficiency Testing encourages you to visit OSHA’s Laboratories page promoting a culture of safety and implementing standards and practices.

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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.

Our Lab’s Public Health Response to COVID-19

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Public Health Laboratories have played a vital role in the response to the COVID-19 pandemic, not only by improving patient testing but also monitoring performance of various methods, training personnel, tracking response, and more. The WSLH in WSLH Proficiency Testing stands for the Wisconsin State Lab of Hygiene, a national public health lab, where our team of Medical Technologists provide proficiency testing (PT) services every day.  As part of a public health lab, WSLH Proficiency Testing’s suite of SARS-CoV-2 proficiency testing products is just one facet of the multi-faceted response that the Wisconsin State Lab of Hygiene (WSLH) is providing to improve accuracy of testing in an attempt to minimize the spread of COVID-19.

WSLH’s response is not only the leading response for the state of Wisconsin, but also nationwide since WSLH is a national reference center for the Centers for Disease Control (CDC). This article is a 50,000 foot view of WSLH’s response to COVID-19, and suggests by labs supporting WSLH Proficiency Testing, they are in turn giving back to WSLH’s public health response efforts.

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WSLH Proficiency Testing provides SARS-CoV-2 proficiency testing products for serology, molecular, and antigen testing; and also offers the SARS-CoV-2 analyte as part of Respiratory Multiplex product. Although helping improve patient testing by participating in proficiency testing is an important aspect of WSLH’s response to the pandemic, the full scope of the WSLH’s public health laboratory response is astounding. Creating new wastewater surveillance methodologies specifically for Covid19, increasing the volume of COVID-19 patient testing and monitoring, and implementing PPE decontamination procedures to be used in the workplace are just some of the many ways the Wisconsin State Lab of Hygiene has responded to the COVID-19 pandemic.

The emergence of Public Health as we know it began with wastewater surveillance methodologies. The work led by our lab’s water microbiology team and state partners builds upon this work as a means to limit the spread of COVID-19. Last September, surveillance sampling began in all but 5 of the 72 counties in Wisconsin. The lab’s wastewater surveillance program includes high frequency sampling for heavily populated areas and lower frequency sampling for rural areas throughout the state.  The process itself includes taking water samples at treatment facilities that represent a 24-hour’s worth of sewage that feeds into a given facility. The samples are then “combed,” so-to-speak, for the RNA genetic material that the SARS-CoV-2 virus leaves behind. These measured concentrations of the virus’s RNA can then tell our scientists how COVID-19 is impacting populations over time. In December, a dashboard was created for the public to view these changes in SARS-CoV-2 concentrations in any of the sewer sheds under surveillance.

To learn more about WSLH’s wastewater surveillance program, read this article on the University of Wisconsin-Madison’s news page.

Throughout the pandemic, laboratory workers and other healthcare professionals in the U.S. have been dealing with shortages of Personal Protective Equipment (PPE). This shortage has forced facilities to re-use or extend single-use PPE, such as gloves and N95 respirator masks. In order to re-use them, the masks need to be decontaminated. WSLH’s Occupational Health Laboratory (WOHL) have brought a critical service to the state of Wisconsin, using UV light decontamination methods, developed by Nebraska Medicine and the University of Nebraska Medical Center. Occupational health and safety consultants at WSLH have created online training videos, conduct live virtual trainings (as onsite trainings have been suspended during the pandemic), and implement PPE decontamination units at facilities. Activities like these under WSLH’s Onsite Safety and Health Consultation Program, known as WisCon, are unique among public health labs, as few conduct occupational safety consultations. To learn more about this program and more from WOHL, visit their page here.

At WSLH, the Communicable Disease Division (CDD) provides reference and specialized testing services in support of public health and ensures statewide access to laboratory expertise and capabilities in the disciplines of bacteriology, mycobacteriology, virology, parasitology, molecular microbiology, and serology. In regards to other statewide COVID-19 surveillance programs conducted at the lab, CDD is also performing antibody testing for the Past Antibody COVID-19 Community Survey (PACCS).  This study is being led by the Survey of the Health of Wisconsin (SHOW) in the UW School of Medicine and Public Health and “…will determine the prevalence of COVID-19 antibodies throughout the state.” Currently, CDD is also managing a multi-faceted suite of grants to build the lab’s response in regards to COVID-19 clinical testing. To learn more about Clinical Testing at WSLH, visit their webpage here.

From the implementation of wastewater surveillance to occupational PPE decontamination, WSLH Proficiency Testing’s SARS-CoV-2 products and technical expertise are just one of the many ways that the Wisconsin State Lab of Hygiene is responding to the COVID-19 pandemic. Thanks to the support of clinical laboratories as well as public grants, the scope of Wisconsin State Lab of Hygiene’s response to the pandemic is ever-growing.  When clinical laboratories enroll in proficiency testing with WSLH, it is wonderful to know that they are supporting many other vital services that build up the capacity of laboratory professionals to respond in their communities.

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Influenza Surveillance at WSLH during the COVID-19 pandemic

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No season this 2020 has been untouched by the COVID-19 pandemic. As we’ve come to find ways to enjoy the turning of the seasons despite, many residents are dreading winter as SARS-CoV-2 cases spike across the United States. Be it holidays without in-person family and friend gatherings or learning new ways to cope with the coming cold weather, everyone has some personal difficulty they are experiencing. Clinical labs have been bracing for the difficult realities from another major wave of diagnostic testing for COVID-19 that, as experts indicate, has not yet peaked as influenza season also approaches.

Laboratory professionals are doing their best to prepare their response, as the Center for Disease Control (CDC) and public health laboratories likewise roll out their responses to aid and serve clinical laboratories as a resource. To learn more about what the Wisconsin State Laboratory of Hygiene (WSLH) is doing as a national public health lab to support clinical labs during influenza this year, I sat down virtually with Erik Reisdorf, Surveillance & Virology Team Lead for the Communicable Disease Division. 

WSLH, which is home to WSLH Proficiency Testing, is doing a lot, I learned, to provide outreach and support to clinical laboratories not only within the state of Wisconsin but across the United States.

 

Everyday behind the doors of WSLH, the Communicable Disease Division (CDD) processes hundreds of tests, not only for SARS-CoV-2 but also for other upper respiratory pathogens. WSLH processes tests to monitor activity of SARS-CoV-2, influenza and other pathogens that may be present in the 5 public health districts of Wisconsin. As WSLH’s Surveillance & Virology team Lead since 1993, Erik Reisdorf and the rest of the CDD team have played a big role in developing WSLH as one of the country’s three National Influenza Reference Centers (NIRCs), which serves to support and strengthen national surveillance activities in collaboration with the Influenza Division of the CDC.

Every week, Reisdorf’s team collaborates with clinical laboratories to receive their testing data and samples, spanning the state of Wisconsin’s 5 public health districts, including rural areas. WSLH further characterizes these surveillance samples by subtyping and full genomic sequencing in addition to culturing the virus and sending the virus isolates to CDC for further analysis. WSLH uses this data from clinical labs to provide situational awareness and monitor the genetic drift of pathogens over time. Beyond WSLH’s role of providing surveillance reports, WSLH also sends data to CDC which is critical to inform vaccine strain selection.

“Everyone plays a big role, all labs,” says Reisdorf. “Our role here at WSLH is to coordinate this surveillance work. The samples that we ask clinical labs to send us helps inform vaccine strain selection and monitor for influenza antiviral resistance.”

Reisdorf also takes time to share with us how WSLH is strategizing their testing plan and how clinical labs might negotiate their own facility and region-specific hurdles to managing diagnostic testing as other respiratory pathogens are on the rise with the coming colder winter months.

Q. With more SARS-CoV-2 cases on the rise in Wisconsin and in the United States overall, how does WSLH’s response to influenza testing look differently this year? 

A. We are dealing with a surge as SARS-CoV-2 samples in support of the pandemic response efforts. Every lab is feeling the crush this year as well. Even as the number of SARS-CoV-2 tests far exceed what we have ever done in the past for influenza, we do have to maintain resources for influenza testing, which is a priority at national level too.

We have a new test, Influenza SARS-CoV-2 Multiplex PCR, which the CDC developed so that public health labs could manage their resources better and maintain this critical public health program. This allows us to not run two separate tests for SARS COV-2 and Influenza. Clinical labs are likely looking at similar multiplex PCR tests as well; and, companies are just starting to roll out those now.

Q. What advice would you give to clinics and hospital laboratories on navigating the kinds of tests available for testing SARS-CoV-2 and influenza? 

A. What sort of test kits and what sort of volumes that clinical labs can get to stay on top of timely testing are everyone’s main pressure points this year. We are hearing of shortages of test kits and labs being on allocation. Regarding allocation, labs may want 1,000 tests a week, but can only receive 100 tests a week, for example. There have been a lot of issues with other testing supplies such as pipette tips too. It has been difficult for us with managing the surge of samples to 1,000 samples per day while also managing reagents and consumables.

How we have best been able to deal with these challenges at WSLH was to diversify our tests and instruments. We now have three PCR tests for SARS-CoV-2 and that has really helped us manage our resources to ensure that we can continue to provide testing.  If we run out of reagents on one test we can use reagents for another test to stay on top of navigating resource challenges.

Q. Any advice or words of encouragement for clinical labs regarding staying on top of patient testing and their own work-related fatigues?

A. Everyone is dealing with stressed staff, shortages of Personal Protective Equipment (PPE) and test reagents and still are doing a great job to maintain as best they can. The testing that clinical labs has done is absolutely critical for public health contact tracing efforts to help limit community spread. Timely testing is also very important, in this regard. Every clinical lab is doing the best they can do with the resources they have and their efforts are greatly appreciated by public health. They couldn’t do their jobs effectively without the timely testing performed by clinical labs.

Also, for updated information on virus activity I would also encourage clinical labs in other regions of the country to look to their states public health lab or department of public health for surveillance reports on pathogens in their state. Every state has their own surveillance program in place. If they are interested in garnering situational awareness for influenza or non-influenza  respiratory pathogens, they can connect with the right people to give them that information for their community.

Given the myriad of upper respiratory infections present during the fall/winter, a big question for many labs is how to ensure they have the right test at the right time in order to have the clearest picture for patient testing success. Clinical labs can look to surveillance programs in their state and nation-wide to help keep the knowledge gap as narrow as possible in diagnostic testing for SARS-CoV-2 and influenza amongst other emergent respiratory pathogens.

Beyond the role of providing situational awareness, public health labs in your state or region can also be a great resource for thinking through testing strategies to help with timely, accurate testing. WSLH Proficiency Testing, and WSLH overall, is a resource to clinical laboratories, state-wide and beyond. We hope that you have found this article informative and want to also take this moment to thank all of our laboratory professionals for the work that they do to everyday to help treat and heal their communities.

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WSLH PT Blog

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A Conversation with Dr. Kurtycz

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Recently, our outreach coordinator, Megan Flowers had an opportunity to sit down with Dr. Dan Kurtycz, who has served as medical director for the Wisconsin State Lab of Hygiene (WSLH) since 1998. Dr. Kurtycz or, “DK” as his students call him, will be retiring at the end of this year. Before he sets sail for his retirement years, we wanted to gather his reflections on his time in the medical community and in the world of proficiency testing through his eyes as medical director for WSLH, the public health lab which is the home of WSLH Proficiency Testing. Below you’ll find an excerpt of the interview Megan had with DK and some of the fascinating conversations shared.

Megan Flowers: How have you seen the world of proficiency testing change since you began your career?

Dan Kurtycz: It’s really come a long way since I started out as a junior pathologist. There were about a dozen proficiency testing providers during the time of my residency where they would start sending samples out of known concentrations and got to see if laboratories would get the same answers. People began complaining, well, you weren’t testing properly and my method is better; so, you began to start seeing controversies.
When I finished residency, there was a program run by the College of American Pathologists called QAS today, where you would send samples out to people and you would test them and give them an answer in their peer group. I was involved in this program as a junior pathologist, and had signed up with CAP to help them. We were in charge of a region where we reviewed everyone’s numbers and notified them when they failed or when they were too far out.

What constitutes being too far out? Dr. Jim Westgard was really important in all of this.  I actually did a fellowship with Dr. Westgard around 1983. Dr. Westgard had involved these things called control rules. If you are running a series of controls with relatively good tolerance limits there is a bell-shaped curve of results that people are going to get. Within this bell-shaped curve, you want everyone to be within at least your results within at least 95% acceptance limits, which by the way is a much higher success rate than what clinicians do when they are diagnosing patients. Westgard evolved a series of rules based in part on 95% confidence limits, 2 standard deviations out from a mean. Westgard’s control rules became very important in the literature and then became built into the machines.  For example, if you have one error in which everything is on one side of the mean then that is likely a systemic error and something is likely wrong with your machine’s calibration or the reagents you are using. Westgard’s series of rules became very important and was promulgated across the nation and around the world from right here in Wisconsin. Everyone was building his methods into their day-to-day practice. I really learned a lot from Dr. Westgard and the whole bevy of people who got involved in Westgard rules and helping refine them.

MF: In the case of the Wisconsin State Lab of Hygiene, what is the significance of having a public health lab also operate as a proficiency testing provider, that entity being  WSLH Proficiency Testing?

DK: Having a division of our lab focused on providing proficiency testing programs was from my predecessor’s efforts, Dr. Ronald Laessig, who was the Medical Director of WSLH at the time. It was important for WSLH as a national public health lab to outreach and provide support to clinical labs on all fronts, including helping labs improve their patient testing through proficiency testing. This was at the same time Laessig was working with Westgard to expand improved methodology and machines. Historically I’ve been more involved with CAP, since I work with CAP as the Medical Director of WSLH. However, what makes WSLH Proficiency Testing stand out in the world of proficiency testing is the ability to provide personable, one-on-one consultations when the laboratory professional needs it. That means a lot.

MF: What advice would you give clinical laboratories regarding their approach to proficiency testing today?

DK: Well, it’s not only about getting the numbers right. It has to be a part of a whole quality assurance program. They have to pay attention to everything from the pre-analytics through the actual testing, running the controls, and to the post-analytics. Quality isn’t only just about making sure your controls are in nowadays. The biggest errors in the laboratory are clerical, where we mess up, don’t track the specimens, and don’t get the right answers to the right people. Also, as laboratory professionals, we need to make it as easy as possible for the clinician to get what they need to take care of people. We tend to run our laboratories as factories and we forget sometimes about the patient at the end of every sample, including those proficiency testing samples that, in the end, help us better alleviate a patient’s suffering. We are not isolated in this work. We are part of the medical community. Let’s not forget the important work we do.

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