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ED Stat Lab


tbostock
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We're a fairly big facility with a level 1 trauma center, 40ish ORs and a large cancer center we support.  We do not have any satellite labs, nor are we even considering it.

Why do you feel this would be better?  Is the ER part of your facility?

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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.

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10 hours ago, tbostock said:

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.

The real problem here seems to be that they want to blame their own errors onto the laboratory, and think that, if they perform POCT themselves, they can get away with these errors.  If you provide a STAT laboratory for them, unless you lower your standards, WHICH YOU MUST NOT DO, they are still going to be making these errors, and the TAT will not improve - ANT THEY WILL SHIFT THE BLAME BACK ONTO YOUR SHOULDERS.

Are you getting any help whatsoever from your own pathology clinicians?

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On ‎3‎/‎22‎/‎2017 at 2:30 PM, tbostock said:

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.

How much or what kind (waived or non waived) cheesy POC testing is currently going on in the ED?  

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  • 4 weeks later...

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.

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Were you able to show them associated cost of running lab (including QCs, PT, competency, staffing) Vs ER puts their act together and give you good specimen (basically fix pre-anlaytics before switching analytic).

We went through this and with 1) the cost we provided to run the lab and 2) improvement in TAT for Ed specimens ....we avoided going to your route...

Actually reporting mis-match historical blood type due to WBIT was big help..

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