The other day a physician ordered a platelet count to be recollected and repeated off lavender and blue top tubes. The patient platelet count had dropped from 229 thousand to 102 thousand in 24 hours, a sudden change. The tech performed the work but grumbled to me the next morning. “He doesn’t trust our lab results! I told him there was nothing wrong with the sample but he wanted a ‘real’ platelet count.”
“That is unusual,” I agreed. “Did you ask him what he was looking for?”
She hadn’t. This would have been a good chance to question the physician. It’s easy to complain that a test seems pointless, but we can provide better results if we ask why. A physician may assume we know what they need, make an honest mistake and want something else, or not have all the information to make the right decision.
For example, every now and then we still get an order for a bleeding time test. We call the physician and explain that a better test (platelet function assay) is available. The doc always agrees. Physicians accept that laboratory medicine constantly changes and generally are open to better technology.
Another common example is a request for a manual differential. Since automated counts are more accurate and percentages misleading, it’s always worth a telephone call to ask what the physician is looking for. If he or she is looking for reactive lymphocytes, the laboratory can perform a targeted smear review and report that information. It doesn’t make a lot of sense to blindly follow an order and report less accurate results than possible with an automated differential.
In the above case, I asked the physician what he was looking for. At a previous job, it turns out, the laboratory would reflex a repeat platelet count on a blue top tube when there was a 50% or greater drop to rule out platelet clumping, an interesting idea. I promised to review our protocol. Thus questioning physicians can lead to quality improvement, an even better idea.
NEXT: Rapid Cycle Improvement