tbostock

Congrats on your retirement. I hope you are not retiring from posting here...we all really enjoy your input.

Currently ED techs draw blood. 40% of the specimens they send have issues (clotted, short sample, barcode on wrong, etc). I am working with the ED to give them more education, training, etc. I really wish our Lab phlebotomists could cover the ED, we would not have these issues. Yes, there is a lot of blame going on right now, so I am proving to them that "garbage in, garbage out". Unfortunately this is political, my pathologists can't change their minds on this. They currently do fingerstick glucose. They want Creat/GFR, urine preg, PT/INR (NO WAY!!!), and Troponin (NO WAY!!!). We are going to start with the Creat/GFR and when it probably fails, we'll come up with a better solution. Like...let Lab do Lab.

I only know of one lab that still does AHG crossmatches on every patient. Waste of time and resources. The resistance to change is always scary to me, after all, we're scientists.

Just addresses hemoglobin, but here you go.Early changes in hemoglobin after RBC transfusion.pdf

We use Softbank with Beaker. I've used them all over the years, and Softbank is by far my favorite.

We also use Softbank and have Epic BPAM and noticed the same problem with massive bleeds. We do the same, make more orders as needed and link them. I understand they are looking at fixing this in a future upgrade.

Yes the ED is in the same building. And we have a pneumatic tube system and a fully automated Lab. But the ED docs are pushing for a ton of Point of Care testing, and we already have tons of problems with compliance with the POC that we already have. So the edict came down: either tons of POC testing or a satellite STAT Lab. The problem with our current TAT for the ED is the very high volume of pre-analytical errors (mislabeling, short draws, clotted/hemolyzed specimens, etc). They think that if they just do all the Lab testing themselves, they will get instant results. So when told I have to do one or the other, I picked the STAT Lab. At least I can staff it with a Lab tech.

We also put our cord bloods on the Tango after removing clots. Works great.

Hello all. Looking for a few contacts on here who have STAT labs in their Emergency Dept. We want to start one here, in lieu of giving them a bunch of cheesy POC testing.

Ours is 2 licensed providers (the second can be an LPN). No students, etc. NYS rules are a little stricter.

Don't take them away unless you find something else we can smash. LOL

Love these WAY too much

Yes, informed consent is part of physician credentialing. It cannot be done by the nurse. You could have your nurses offer an info sheet to patients, but the conversation about risks, benefits, alternatives, and consequences of refusal MUST be a conversation between patient and physician/provider (can be PA or NP but not an RN).

I use the Genesis tube sealer. Love it.

Been live with Softbank and Epic for about 7 years. I'd be glad to help. I'll PM you my email and phone.

For the weak antibodies with no apparent specificity, we have determined that to be clinically significant in our LIS to ensure that the techs do the AHG crossmatch on these...just in case.

In NY State, their updated regulations ban the use of any expired reagent, validated or not.

I use "current edition" for all of my SOPs and have a cover page in each SOP manual showing which version is being used currently, with the edition number and date started. I've had a few inspectors challenge it over the years based on their personal preference, but they can't really find a way to cite you for this.

Just passed my SBB last year. I am enrolled in the Rush University SBB/Master's in Clinical Lab Management program (all online). As soon as I just enrolled in the program I started getting job offers. And before I finished the Master's part, my current job promoted me. So yes, the SBB will get you places. You will always have a job if you are willing to be challenged.

Congrats Malcolm!

We use Ortho gel; as soon as Bio-Rad's gel is FDA approved, we will switch. I really like having the two methods (gel and solid phase); lets us do a lot in house without having to send to a reference lab.

Horrible idea. The existence of Lab Assistants is becoming more popular too; and their range of duties is expanding (outside of CLIA regs of course). We are one of the only medical professions that seems to want to "dumb itself down". Physician therapists, pharmacists, PAs, have all raised the bar for themselves by requiring higher degrees and certifications. In my state (NY) that has licensing, some labs are trying to get around it by using foreign workers on temporary work visas; get them in and out before anyone notices. It's getting crazy due to the shortage here, but I feel like the worst thing we could do is get more lax in who we allow to result lab tests.

We went live with Epic's BPAM this past October. Not a bad system, but we are still struggling with nursing compliance.

I have Epic for our EMR and SoftBank (standalone) for our BB system. I LOVE SoftBank. We had both systems for 6 years. Private message me if you have specific questions.

I was also very happy to hear this. My legal department was struggling over this. So now we are just going to send a more general memo to all of our physicians about Zika and the increased risk in transfusing pregnant women.