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  • Is Your Lab Prepared for Ebola?

    Just a few short months ago Ebola was a disease in a far away continent. The greatest fear was that with our internationally mobile population a case or two might slip into the USA. Then 2 Americans in Liberia contracted the disease and were flown back amongst great fanfare to Atlanta's Emory Hospital where they were treated for several weeks, ...
  • Does Tech Support Believe You?

    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 a shift wasn’t a shift, and (basically) that none of us knew what we were looking at. He ...
    Posted to Stepwise Success (Weblog) on March 19, 2014
  • All The Other Labs Do It

    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, but it can also be misleading. Curious providers can use online calculators, preferable to ...
    Posted to Stepwise Success (Weblog) on January 31, 2014
  • Questioning Physicians

    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 ...
    Posted to Stepwise Success (Weblog) on September 4, 2013
  • ABO Compatibility Safeguards

    The incidence of ABO-related transfusion complications is rare but significant. One study estimates 800-900 cases annually in the US, with most causes being identification or phlebotomist error. Considering that undetected errors can occur depending on the patient type e.g. a group A patient may safely receive a unit of O in error, the true rate ...
    Posted to Stepwise Success (Weblog) on July 5, 2013
  • Speed Kills

    As clinical laboratorians we are taught the importance of the information we provide for clinical decision making.  Technology has made it possible to use small sample sizes to generate ''numbers'' in a very short period of time. Sometimes physicians (and laboratorians) get so seduced by the speed that we forget that numbers are only ...
  • When Do You Sleep?

    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 Department of Labor web site, “shift work” is defined as between seven P.M. and seven A.M. ...
    Posted to Stepwise Success (Weblog) on August 13, 2012
  • A Good Rejection Policy is Fair

    When I told nurses we would throw unlabeled specimens in the trash and then telephone them with the news, outrage ensued. “How dare you!” was the general tone. Perhaps, they believed this was their decision. At least, I played fair by giving notice. Laboratory policies and procedures need criteria for specimen rejection. CLIA interpretive ...
    Posted to Stepwise Success (Weblog) on October 28, 2011
  • Contagion: A Nice Nod to the Lab Community

    I just saw the blockbuster movie Contagion and must say I was pretty impressed. When I watch a medical-themed movie, I always look at it with a critical eye. How factual is it? Is it authentic in terms of scenarios, equipment, procedures and vocabulary?I look for how realistically roles are portrayed. For example I tend to roll my eyes and become ...
  • Are Disclaimers Ethical?

    We’ve all added a comment to a report like the following: “Specimen hemolyzed. Results may be falsely elevated.” A disclaimer can be added “just in case,” per lab policy or package insert, or to cover a tech’s behind. Sometimes, we let ourselves be bullied into giving a result with a disclaimer. We assume the physician can interpret disclaimed ...
    Posted to Stepwise Success (Weblog) on April 15, 2011
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