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Tag: clinical laboratory professionals

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

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.

WSLH PT Staff Spotlight: Meet Tracy Servey

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

Meet Tracy Servey! Tracy is a Medical Technologist and Proficiency Testing Coordinator for WSLH Proficiency Testing. Hailing from the Mid-Atlantic region of the United States, Tracy grew up in Meadville, Pennsylvania. Upon graduating high school, Tracy attended college at the Clarion University of Pennsylvania and at the St. Vincent School of Medical Technology, graduating with the class of 1997.

Tracy got her start as a bench generalist (MT ASCP) in northwestern Pennsylvania, where she worked for 10 years before moving to the Midwest to be with WSLH PT. She is now approaching her 15th year with WSLH Proficiency Testing!

At WSLH PT, Tracy coordinates microscopy modules, including provider-performed microscopy, hematology cell identification, as well as body fluid cell and crystal identification. She also coordinates hematology, urinalysis, and several quality assurance modules. Tracy enjoys the friendly environment and wealth of knowledge she is surrounded by every day at work. When she is not working, Tracy loves camping, hiking, exploring the outdoors, and spending time with her husband and two Norwegian Elkhound dogs, Leif and Truce. Tracy is looking forward to spending the winter months in her bunkhouse cabin in Northern Minnesota, which she and her husband finished building together in late summer.

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

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 Testings 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.

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.

Remembering Our Laboratory Leadership

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.

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.

WSLH Proficiency Testing Staff Spotlights

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!

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.

Decentralized Testing: Effect on the future of laboratories

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Laboratory professionals are seeing more and more testing moving away from the central lab. The tests might be at bedside, in the phlebotomy station, in radiology, the emergency room, ICU, and even at home. These tests are being performed by nurses, clinicians, and medical associates. Additionally, medical professionals are sending more complex testing that does not require rapid turnaround time to reference laboratories. 

What does that mean for the average hospital or clinic laboratory? What is our role as professional laboratorians in this changing environment? What are the advantages and disadvantages of this exodus of testing from the main lab?

Point-Of-Care Testing (POCT) has enabled rapid results to be obtained while remaining with or near the actual patient. The advantages of this proximity of processing tests to the patient are apparent in the ability to administer insulin 

or other life-saving medicines within moments clearly improving patient outcomes. In the case of radiology, another advantage is efficient workflow as a technician is able to evaluate the safety of administering contrast media through sampling creatinine (kidney function) levels. Obviously, these advantages are significant when it comes to patient outcomes, but there are risks as well.

POCT, from the individuals who are asked to conduct the tests to the test quality itself, comes with a number of concerns that are exacerbated by the increased proliferation of such tests. The greatest risk is the fact that you are placing testing in the hands of individuals who have not been trained in understanding the importance of quality control and in recognizing poor results. Therefore POCT is often considered the lowest element on their patient care list. My sister has lived this experience. In her 40 years as a registered nurse, she says, her focus was patient comfort. While testing was something that had to be done, there were far more immediate concerns that had to be addressed. An excellent educational foundation sets up individuals for success. Given that the education of laboratory professionals gives primary focus to the study of analytical procedures, testing done in a core laboratory lends to more reliable, quality patient testing.

There are certainly benefits and risks to weigh in medical professional settings when deciding to outsource testing from the core laboratory. This not only includes POCT but sending tests to reference laboratories. Weighing delays created by sample transport for referral testing against patient outcomes must be a consideration since test results drive the majority of medical decisions. Norman Moore, PhD, director of scientific affairs for infectious diseases at Alere Inc. says that, “the main advantage is that outsourcing usually saves cost per test. However, we are finding that the cost savings on a test level are not balanced by the cost on a patient level in most instances.” Often clinics and hospitals may decide to outsource given that a referral lab can process many tests at a time versus at the pace of the technician or technicians available to process tests one-by-one in house. The ability for referral laboratories to process large batches of testing samples is often also seen as a way to address laboratory staffing shortages. Dr. Moore adds that outsourcing for the purpose of cost-saving is not very advantageous for patient care, given that referral testing delays access to results which, in turn, delays the healthcare provider’s ability to provide a timely diagnosis for the patient.

During the winter time, when the spread of respiratory infections are at their peak, it is important to diagnose and treat early. Furthermore, this need for a quick testing response is more acute in emergency room settings to address emergent patient needs. Outsourcing, especially in context of the growing availability of more samples that can process multiple tests at once, is not sustainable in the long-run, regarding budgets and, ultimately, patient care. It seems that keeping testing in-house, while also addressing laboratory staffing shortages that put a strain on providing timely, accurate patient testing brings us back to the question of Point-Of-Care Testing to help alleviate challenges.

POCT is a proven approach for providing a faster turnaround time of laboratory results. What must be addressed now, as companies continue to improve POCT equipment, is how hospitals and clinics can assure best practices in POCT. I would encourage laboratories to actively engage in training, quality control and proficiency testing for the point of care testing areas. Last year, AACC released a guideline that can help administrators and lab leadership define POCT performance in their facilities. The key questions that they ask are:

  • What is the value of an interdisciplinary committee to oversee POCT?
  • Does education improve POCT performance?
  • What is the optimal staffing model for POCT?
  • Do proficiency testing (PT)/external quality assessment (EQA) programs improve POCT performance and patient outcomes?
  • Does data management improve POCT outcomes?
  • How should staff select POCT devices?
  • How does POCT improve process?

I would highly recommend that facilities use this guideline to not only help define their current POCT performance but to help develop best practice in POCT.

Several years ago, the AACC released an article aimed to help facilities improve POCT compliance through preparing staff for routine inspection. If nurse leadership and other medical staff responsible for POCT know what questions inspectors may ask and what staff can anticipate, the work towards the standardization of accurate POCT can start to become more integrated among all staff involved. In other words, preparing for a POCT inspection can serve as a starting point for staff to start defining POCT performance and to start implementing best practices in POCT.

In addition, testing across multiple platforms should occur to prevent discrepancies between in-lab testing and POCT. I would also caution that the laboratory evaluate testing to remain in house vs. sent out based on patient critical need. If facilities intend to rely on referral testing, the referring laboratory must ascertain and have available the credentialing of the reference laboratory such as the CLIA and/or CAP certificate.

Point-Of-Care Testing is here to stay. Outsourcing lab work is a strategy that isn’t going anywhere. These facts highlight the importance taking a closer look at our current practices outside of the core laboratory and weighing them against our patient care outcomes, especially if we are approaching our questions from a cost-benefit analytical framework. Professional organizations such as the AACC have provided the latest resources to help hospital and clinic staff to improve POCT best practices and assure POCT compliance.

Take advantage of those resources and keep an eye on helpful articles from proficiency testing providers and regulatory agencies for helpful tips and guidelines to tease out the more complex side of planning, organizing, and coordinating POCT and referral testing. Core laboratories are encouraged to partner with nursing staff and other medical personnel to create training infrastructure on POCT analysis. Laboratory staff can also help implement a routine, internal audit of POCT practices that is POCT compliant with regulatory agencies, which in turn, helps everyone involved be inspection ready.

Reference:  The Shift to Point of Care Testing: In Clinical Chemistry Q&A, lab industry leaders look at impact of technology, reimbursement, other factors in move from hospital-based settings.
Date: NOV.12.2015  // Source: CLN Stat

WSLH PT Blog

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The Future of the Medical Laboratory Professions

We’ve all likely heard the statistic: 70% of medical decisions are based on laboratory diagnostics. During Medical Laboratory Professionals Week, aka “Lab Week” we are reminded of this and other ways we make meaningful impact in patient care. It’s a week of celebration, but also a week to heighten the visibility of our careers, as much of the public is still not as aware of our profession and our contribution to patient care. With the onset of a global pandemic, many members of our professional community indicate Phlebotomists, Medical Technologists, and Technicians have gained significant visibility as media outlets cover the COVID-19 testing efforts. Last year, the New York Times published an article about the stresses medical laboratory professionals face, including many personal stories of long hours, sleepless nights and lack of social interaction with the demands of increased testing exacerbating pre-pandemic issues, such as staffing shortages. Never before has the public had such an in-depth look at the word of medical laboratories. In this article, educators and scientists speak to the importance of increasing meaningful visibility in the media and in classrooms in order to help attract and grow a pool of qualified talent in medical laboratories.

Michelle Schulfer, Clinical Coordinator and Senior Lecturer for Clinical Laboratory Science at the UW-Stevens Point, says while there is some increased visibility in the media due in part to the pandemic, there’s a lot of missed opportunity to give the people featured in the B-roll footage of the local news an identity. Often Michelle will be watching the nightly news report on the latest testing efforts at the local hospital and spot some of her former students in the broadcast. Occasionally, the station will air a clip of one of the reporters talking with the hospital’s lab manager, who is also a former student of Michelle’s.

“I think to myself, ‘tell the reporters who you are and what you all do!’ People know about doctors and nurses, but they do not know our name as medical laboratory professionals. People need to hear our profession name and what we do, so they can aspire to it,” said Michelle.

Such missed opportunities in the midst of ongoing staffing shortages could be alleviated by a deeper public focus in the news media. “We are doing great things. It’s important to give our work an identity,” adds Michelle. She also addressed the importance of the stories, nuances, and opportunities that exist for both Medical Laboratory Scientists and Medical Laboratory Technician. Leah Narans, Program Director of Medical Technician and Phlebotomy Programs at Madison College, agrees and discussed the importance of word-of-mouth outreach, including strategies such as inviting Medical Technologists and Technicians to talk with grade schools about what they do, whether it’s part of a science unit or career learning opportunity.

“It’s important to reach out and connect with high school counselors and give them a name for what we do,” Leah Narans says. “Again, it’s all about the name.” Before the pandemic hit last year, Leah Narans spoke with 60 high school counselors. In the meeting, Leah discussed the 2-year program at Madison College, where students are getting certified, getting 100% job placement, and then getting tuition reimbursement if they decide to go on and get their Bachelor’s Degree and their Master’s Degree to become a Medical Lab Scientist or Lab Manager. “Their eyes nearly exploded with amazement when I told them,” said Leah. “They had no idea what to expect!”

As educators work to increase enrollment in medical laboratory science education programs, they discuss the urgency of their work given other external factors that are both within and beyond the scope of the pandemic. One factor that Michelle and Leah both discuss is the possible “retirement bubble,” that may further widen during the course of the pandemic. According to the Medical Laboratory Observer’s 2020 Annual Salary Survey report, 45% of all medical laboratory professionals have a minimum of 20 years’ experience, with 31% having 25 or more years of experience.

Only 23% have 5 years or less of experience. At the same time, medical laboratory sciences can expect a lot of job market growth in the coming years.

According to the Bureau of Labor Statistics, the overall job outlook for Medical Laboratory Scientists and Technicians is solid, expecting to grow 13% between 2019 and 2029, faster than the average for all occupations. The government attributes this growth in part to the aging population, leading to additional diagnostic testing. According to a survey report in the May 2018 issue of the American Journal of Clinical Pathology, this data “strongly suggested the crucial need in the supply of qualified and certified laboratory personnel.” With a “retirement bubble” potentially on the horizon and there being a growing need for lab qualified and certified professionals, recruitment and retention of students in accredited Medical Laboratory Science programs is key.

In a recent “Inside the Lab” podcast episode produced by ASCP, three educators discussed the educational recruitment and retention strategies and resources available to them to address this issue. Strategies shared included implementing more practical lab experience for high school students and inviting Medical Laboratory Professionals to teach a special lesson to students, during a unit on blood, for example. The podcast also highlights resources that ASCP offers to assist with such strategies—ASCP’s Patient Champions curriculum that can be incorporated into lessons and ASCP’s Career Ambassador’s program, which encourages Medical Laboratory Professionals to share their passion for their careers with students, and how they can make a difference as a Medical Laboratory Scientist or Medical Laboratory Technician.

Laura Schreiber, Microbiology Proficiency Testing Coordinator for WSLH Proficiency Testing, says “I would want to show students how exciting it is to get to read about a new test that could make a great impact, and then getting to perform such a test in the lab a few years later. Being a part of a rapidly changing field where I am learning something new all of the time is very fulfilling.”

Laura worked on the bench for years (and still does part-time), before deciding to pursue her current position as a coordinator for a proficiency testing provider. She adds that while both jobs comes with its challenges, her love for her jobs both on and off the bench to improve laboratory quality outweighs the rest. She said she does not take for granted the love she has for her work as a Medical Laboratory Scientist.

Laura was a few years out of college, working in a different field, when she realized her career wasn’t fulfilling. She saw how happy her Mom seemed in her career as a Medical Laboratory Scientist, and wanted to capture that same career fulfillment. She was inspired to follow her Mom’s path, while forging her own as a Medical Laboratory Scientist specialized in Microbiology.

“I always loved Microbiology as a kid,” said Laura. “Having dedicated teachers and people in my life who supported my curiosity and interest in Microbiology made all the difference.”

Stories like Laura’s are important to tell, so that other individuals aspiring to make a difference in their careers can see what is possible. As the need for qualified medical laboratory professionals grow, educators will work to increase the number of graduates to fill vacancies in the laboratory. For those of us in the lab full-time, we can amplify such strategies by providing virtual (and eventually in-person) shadowing opportunities, classroom visits, and story sharing. Sharing our journey and our passion as medical laboratory professionals not only during Medical Professionals Lab Week but year-round will help grow the time and talent we need to maintain a happier, more sustainable workforce and laboratory quality, overall.

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On The Road Again: A Look at the World of Tradeshows

 

By Kristine Hansbery
Director of WSLH Proficiency Testing

Adapting to the new world of digital technology and virtual communication has presented both opportunities and barriers. The COVID-19 pandemic has necessarily pushed us further into the world of virtual communication which, in turn, has effected the way we do events and tradeshows. These events have always provided the ability to acquire much needed Continuing Education Units (CEUs), and wonderful opportunity to network with our peers.

 

Numerous vendors and show sponsors have recreated this important venue in a virtual setting for laboratory personnel as well as vendors promoting their product. There have been some successes and some, well, not so much. This article provides a closer look at this world of virtual events that have been rather hit or miss, and those perennial favorites of the past, and what makes them so special. We at WSLH Proficiency Testing hope this guide provides potential show attendees with the opportunity to explore new shows as well as make informed decisions regarding the expense and value of each venue.

There just is no way you can replace human contact with virtual events. Something must be said regarding the person-to-person networking that happens at each event. Capturing the attention of attendees at a virtual venue can be difficult given that the structure at in-person events encourages networking naturally. From the perspective of a vendor, the best virtual event by far for us was the Lab Director’s Summit, sponsored by MLO. This event actually created events that mimicked the real one-on-one conversations that would exist at a live event. They took it a further step by allowing vendors to present their product line as a 30-minute presentation to attendees in the following ways:

  1. Have one-on-one meetings with each and every attendee (like a dating event). The vendor has a 15-minute meeting with an attendee, a bell rings and then the next attendee arrives in the booth.
  2. Initiate meetings either set by the attendee or the vendor, in a polite nonintrusive manner.

While the best of the virtual world allows for greater connection and networking, we have all experienced the limitations with this format, technologically and socially. It’s important for our species to connect and see each other in-person. Plus, how much more eye-strain and zoom fatigue can we handle, given that much of our personal lives are online these days? While we hope we can return to real-life shows in 2021, let’s take a look at some of the top live events that we find rewarding and, let’s face it, just plain fun.

American Society of Clinical Laboratory Scientists (ASCLS) meetings
While each and every one of these ASCLS state-sponsored events are good, some stand out as particularly engaging.

ASCLS Minnesota takes place yearly at the Earle Brown Center, which captured the horse lover in me with old timey pictures of the largest horse in the world (at one time) as well as some race horse facts and other photos. The venue is very well attended by both laboratory professionals and vendors. The opportunities to network are plentiful. What a great show!

ASCLS Montana provides one of the most welcoming shows with beautiful scenery wherever you look.

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How We Cope During COVID-19

As we ring in the New Year, with hopes, goals, and challenges in mind, medical laboratory professionals continue to respond and adapt with inspiring tenacity to assure quality patient testing. Self-care has never been so important to minimize burnout and promote a more sustainable workplace. We hope what we share below encourages you to share with us how you and your team cope with stress through adaptive strategies like resource-sharing, self-care, and storytelling. Please share with us by replying by email at ptservice@slh.wisc.edu.

As we challenged assumptions about our own ability to adapt and learn new ways of working, we forged through some of the most difficult realities of our working life during the COVID-19 pandemic. Our individual and collective journeys as laboratory professionals have taught us lessons to help us adapt to difficult situations and conditions, or have taught us that a different career trajectory is possible, and needed, for our own well-being.

Should we decide that we might survive and thrive better in healthcare settings than in other workplace settings, finding healthy coping mechanisms has been integral to minimizing burnout and compassion fatigue, beyond the other immediate health problems that have come with the job throughout this pandemic.

According to an article published in July 2020 in the American Journal for Infectious Control, the primary ways that healthcare professionals managed best to cope with the stresses of their jobs included:

limiting their own exposure to media coverage and social media; limiting sharing their COVID-19 duty details with loved ones and community members; coping through religious practices and spiritual communities; and building capacity for altruism and empathy. Based on studies like these, the Centers for Disease Control and Prevention also recommends and provides some tips for adapting healthy coping strategies to manage stress, avoid physical or mental fatigue, and build resilience.

It is important to validate your feelings and experiences first in order to be able to recognize the need for self-care, indicates The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) in an article they released in July 2020. In their article, SAMHSA points out the signs of disaster-related distress and compassion fatigue; and offers tips and resources for getting help. They offer a downloadable pdf on their website; and it is suggested to print out the last page regarding resources and post it somewhere in your facility.

Regardless of our job titles, we all have important contributions to make to the stream of life and the web of humanity. As medical laboratory professionals and healthcare professionals, dealing with the unsustainability of work conditions present challenges that no human should be asked to overcome, and yet you have. How have you and your team promoted a more sustainable workplace through adaptive strategies like resource-sharing, self-care, and storytelling? Please share with us by replying by email at ptservice@slh.wisc.edu.

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Influenza Surveillance at WSLH during the COVID-19 pandemic

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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