Stepwise Success : Diagnostics

Improve Your Criteria

Scott Warner — Wed, 17 Apr 2013 10:04:00 GMT

An acronym pulled from the alphabet soup is CQI, or Continuous Quality Improvement. Managers and quality improvement people use this to show that everything can be improved, even processes that work. Continuously trying to improve quality generates incremental...(read more)

Why Fasting?

Scott Warner — Fri, 12 Apr 2013 09:58:00 GMT

Each day, I see people arrive for work after they have had breakfast at home. They sometimes arrive with coffee. Within two hours or so they go to morning break and eat a muffin, fruit, or some other snack, often with more coffee. Two hours later they...(read more)

The Lab Did It

Scott Warner — Mon, 17 Dec 2012 11:13:00 GMT

The laboratory is often blamed for things, the dog at day’s end that gets kicked. Judge and jury often work outside our doors and call to inform us of the sentence. “The lab did it!” in other words. We’re left like a Peanuts character sighing in exasperation....(read more)

Do You Still Report Bands?

Scott Warner — Wed, 12 Dec 2012 11:00:00 GMT

It was not very long ago that I heard “What’s the band count?” It seemed commonplace for surgeons to decide to operate on the basis of them. ED physician assistants and doctors waited for them, too. And don’t get me started on pediatricians. In the laboratory,...(read more)

Patient Instructions

Scott Warner — Mon, 19 Nov 2012 11:07:00 GMT

Immunological fecal occult blood (iFOB) testing is becoming more common, because the tests offer greater sensitivity and specificity, do not require multiple samples, and forego dietary restrictions. But collection instructions are more complex. The Hemosure...(read more)

Is Molecular Testing the Holy Grail?

Scott Warner — Wed, 14 Nov 2012 11:11:00 GMT

“Go and tell your master,” King Arthur offers a French soldier in Monty Python and the Holy Grail , “that we have been charged by God with a sacred quest. If he will give us food and shelter for the night, he can join us in our quest for the Holy Grail.”...(read more)

Not Ready For Prime Time

Scott Warner — Mon, 22 Oct 2012 10:00:00 GMT

Last year I asked for an early proposal to upgrade our chemistry analyzer because of method performance. The physicians will like better low-end precision, I reasoned. But the ED director said, “I don’t think that’s quite ready for prime time.” I’ve heard...(read more)

When Do You Sleep?

Scott Warner — Mon, 13 Aug 2012 10:16:00 GMT

When a night shift tech resigned for another position I was told, “If you can’t hire someone, just rotate your day shift through nights.” That is a possibility, of course, but there is no “just” about it. According to a 1981 article published on the US...(read more)

Junky Cultures

Scott Warner — Wed, 08 Aug 2012 10:13:00 GMT

It would be great if we received cultures from only sites expected to be sterile: blood, deep wounds, body fluids. In areas where the immune system gobbles up microscopic critters, properly collected positive cultures are instructive. The physician is...(read more)

Rounding Up Problems

Scott Warner — Fri, 03 Aug 2012 10:11:00 GMT

One of our quality indicators is how quickly we turn around a request to recollect a contaminated urine specimen. In other words, a reflex urinalysis is ordered that should be cultured but has enough squamous epithelial cells to indicate contamination....(read more)

Contaminated Urines

Scott Warner — Wed, 25 Jul 2012 10:02:00 GMT

Many laboratories have microscopic criteria to reflex to culture. Yours may include WBC and/or bacteria seen. You may also reject the sample for culture as contaminated if there are too many squamous epithelial cells (e.g. greater than 10 per LPF). How...(read more)

Lab Order Sets

Scott Warner — Fri, 20 Jul 2012 10:12:00 GMT

Traditionally, an inpatient medical record contains handwritten physician orders that are a mix of transcribed orders (e.g. a doctor telephones a nurse to request lab tests), free text orders written in a stream of consciousness style, and printed forms...(read more)

Explaining Errors

Scott Warner — Mon, 16 Jul 2012 10:03:00 GMT

Nurses are often go-betweens for doctors and lab techs, speaking for either. For the laboratory, it usually doesn’t matter if the nurse represents the doctor (“He wants a STAT potassium on the patient in 12”), but is the reverse true? Recently, for example,...(read more)

Joint Fluid Crystals

Scott Warner — Fri, 08 Jun 2012 10:27:00 GMT

New procedures can generate excitement and anxiety. Joint fluid crystal analysis is a good example. Implementation involves the following: Purchasing a new or retrofitting an older microscope with a gout kit (on the cheap this might be $1000 or less,...(read more)

The Sed Rate of Micro

Scott Warner — Mon, 21 May 2012 10:03:00 GMT

We laboratorians (ha ha, really) must seem a humorless clique. We stick together at breaks and lunch, are all business on the telephone, and are otherwise inside our black laboratory box. And like most work teams, we have pet peeves funny to only us....(read more)