Rarely Ordered But Critical Tests
The bread and butter of labs are those tests ordered on most patients: chemistry panels, blood counts, urinalysis and culture, and to an extent coagulation and blood bank. These are often ordered serially on patients admitted to your hospital, creating a cumulative report of laboratory values. As professionals we tend to be most productive and competent performing these tests, or at least operating the instruments that produce them.
But it is those rarely ordered but critical tests that can drive new technology and make us valuable to clinicians. Not just anyone can run them.
For example, in Maine many people use wood heat or are shut in for much of the winter. Carbon monoxide poisoning is a seasonal risk. These patients arrive at our ED, and it would be good if a physician could have a carboxyhemoglobin level STAT. Instead we offer this test as a sendout to our referral lab. It’s rarely ordered, instrumentation is costly, the docs don’t complain about not having it except (naturally) when they really need it, and when the weather warms it falls off the radar. It’s a good example of test that when the doc needs a result, he or she needs it now and not in two to four hours.
These rare but critical tests present unique challenges. They are expensive to keep in house, sometimes difficult to verify and control, more likely to have expired materials, and are harder for techs to remember how to do. Since they can be ordered in an urgent context, the latter is a real problem. It isn’t a problem to put a STAT chemistry panel on a busy instrument designed to prioritize STATs, but cerebrospinal fluid testing, for example, is always disruptive -- ask any night tech!
“Rare but critical” is the reason laboratories need highly trained professionals. Running routine specimens through analyzers isn’t worry-free, but variables are limited and repetition ensures a degree of competency. But a rarely ordered test ordered on a critical patient is already a problem.
We’re looking at the Avoximeter to resolve our carboxyhemoglogin issue. Is anyone using this?
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