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Rarely Ordered But Critical Tests
July 23, 2014 6:05 AM by Scott Warner
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 Read More...
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A Better Marker for DKA
June 25, 2014 6:04 AM by Scott Warner
The nitroprusside test typically performed with a Bayer Acetest tablet is a laboratory classic. It’s one of the first tests I learned. In the nitroprusside reaction, acetoacetic acid, a serum or urine ketone, reacts with sodium nitroferricyanide and glycine Read More...
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Better Counting
June 20, 2014 6:11 AM by Scott Warner
We do a lot of counting in the laboratory: white blood cells, abnormal red cells, urine formed elements, and microbiology colony counts. I’ve worked in labs where these are precise, for example, reporting urine microscopic red cells as rare, few, 0-1, Read More...
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It’s All About Technique
April 30, 2014 6:14 AM by Scott Warner
Running lab tests can look easy but often isn’t. Consider a common serology test, the heterophile screen. The OSOM Mono Test is one random example. The package insert lists the following with pictures: For serum, plasma, or whole blood samples in tubes: Read More...
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Are Mistakes Systemic?
April 25, 2014 6:14 AM by Scott Warner
The more I deal with process design, the more I suspect human error is systemic. Not that we are flawless workers -- one author parses mistakes and slips by intention or outcome -- but we give the system a pass too often and blame human error. We work Read More...
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Revisit Your Kits
April 7, 2014 6:01 AM by Scott Warner
Our laboratory uses many “plop plop fizz fizz” tests for qualitative screening, like most labs. These quick and easy tests have been in labs as long as I can remember with a few enhancements over the years that have made them even easier e.g. internal Read More...
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Does Tech Support Believe You?
March 19, 2014 6:04 AM by Scott Warner
More times than I can count I’ve discovered a problem with an instrument because of an unexpected shift or trend in quality control, called tech support, and been told there isn’t a problem. Recently a hematology field service tech told our techs that Read More...
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Culture or Not?
February 14, 2014 6:01 AM by Scott Warner
Culture or not? is not a straightforward question. We tend to see specimen results while the rest of the team sees the whole patient. Recently we talked to a hospitalist about a urine culture that had been collected by the ED as a reflex urinalysis prior Read More...
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All The Other Labs Do It
January 31, 2014 6:07 AM by Scott Warner
We report an estimated GFR using the MDRD (Modification of Diet in Renal Disease) equation. Sometime last year we stopped reporting the value in patients over seventy, because it hasn’t been validated for that subset of patients. It can still be useful, Read More...
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The Skinny on Fats
January 27, 2014 6:07 AM by Scott Warner
I knew an old country doctor who ordered lab tests to confirm what he already suspected. Dewey would say it’s more important to treat the whole patient. He used cholesterol as an example. “I refuse to treat a lab test!” he would exclaim. He had dozens Read More...
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Why Culture?
December 24, 2013 6:05 AM by Scott Warner
Microbiology techs are like detectives where the motive for a crime remains a mystery. Identifying the weapon requires expertise. Staphylococcus epidermidis , for example, is normal skin flora in a surface wound and a contaminant in many others. If a Read More...
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No Growth Cultures
October 16, 2013 6:01 AM by Scott Warner
How do you keep a physician in suspense? Ask him or her to order a culture. In small labs where most routine cultures are urine, sputum, blood, and surface wounds, there can be a daily battle between getting microbiology results in the hands of the docs Read More...
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Interpretive Comments
October 7, 2013 6:08 AM by Scott Warner
Laboratory report formats can be cluttered with interpretive comments. While useful for the sake of providing complete and accurate information specific to the test, they can easily become a distraction. At a recent lab manager meeting the group discussed Read More...
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Keeping Micro
September 27, 2013 6:04 AM by Scott Warner
The great things about a small hospital are exactly why it is important to keep micro: a close connection over time with individuals in the community, a good working relationship with a small group of doctors, and a limited number of nurses to educate Read More...
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Outsourcing Micro
September 23, 2013 6:10 AM by Scott Warner
I’ve been asked more than a few times in the last dozen or so years to outsource microbiology. It saves money, doesn’t affect turnaround time, and improves quality. Duh! is implied. Really? I wonder. Saving money. Whenever administration talks about saving Read More...
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About this Blog


    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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