Time Mastery

One of my favorite song lyrics is from “When I Find Home” by Cody Chestnutt: “I only got time to think about the time I don’t have” I like this lyric, because when I get really busy I sometimes enter this “freeze” moment, where I am stuck thinking about all the things I have to do without being able to do any of them.

As our work continues to get busier and busier, it is becoming more critical to have good time management skills. However, to actually master time, people need more than To-Do lists. This course focuses on twelve different categories of time mastery and participants assess their skill level in each of these areas:

  1. Attitudes
  2. Goals
  3. Priorities
  4. Analyzing
  5. Planning
  6. Scheduling
  7. Interruptions
  8. Meetings
  9. Written Communication
  10. Delegation
  11. Procrastination
  12. Team Time

However, not all of the categories are equally important in a current position. I might have no direct reports, so even though I might score low in that category, it is not really important in my current job. Based on participants’ answers, the assessment automatically creates a Skills Gap Analysis, a table in which the categories are organized according to two axes: less important to important and less skill to more skills. These tables gives participants a quick overview of which categories they have marked as more important, but have less skill in. In other words, these are the areas of development.

Mastering time and moving away from thinking about the time that I do not have, has allowed me be more proactive about my time and schedule. My written communication and meetings are more productive and better organized; I am clearer in my delegation and define authority levels; I follow my yearly goals more closely and I take the time to analyze when and why I am interrupted or interrupting, to understand what could have been communicated better. Mastering time has allowed me to rarely experience stress while at the same time being more productive. I only got time to think about the time I do have.

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


 

When many of us are asked if we would be interested in learning more about improving our time management skills, our response, maybe “Yawn, I got this, after all, I am a busy professional.” What we often don’t realize is that getting to the goal, no matter how hurried or rushed, is not just often about you. Our work pace impacts others in the workplace and if we want to become a true leader, we need to master ourselves first. The first place to start on this is how we manage our time.

We have an expression in our family: “we’re always working for the farm.” When you are running a farm, you don’t get to choose your own timing or schedule in the projects that must be done. The seasons come and go and there is planting and harvesting to be done on nature’s time. There are animals to be fed and fences to be mended on nature’s time. Understanding some of these basics help us to realize that there is time in one’s schedule that we can control and time in one’s schedule that we don’t control.

As for the time you can control at work, you can select when to answer your emails, and when to have “that open door” for workplace issues, and when and how to prioritize your projects. In some cases, like the farm, you will not get to always control your own schedule and choose when important events or meetings happen. So to help with this, we can paraphrase Mark Twain: “Eat your frogs early.” This means doing your biggest and hardest task first thing every day so that you prevent procrastination and free up time in case other urgent situations emerge. For some, that may be a phone call dealing with a patient or employee complaint; for others, it may be tackling an unresolved operational issue that needs to be urgently addressed. Whatever it is, go at it first and efficiently and get the job done.

When we look to improve how we master time, we need to have an understanding of what is urgent and important and what is important, but not urgent. The best advice for time management is to work more on what is important, but not urgent, to prevent everything from becoming a last minute urgent need. If you are often focused on urgent issues every day, you are simply putting out the fires at work and never getting to the optimal operational efficiency in your area. You can begin to master this by simply blocking out a time every day that you will work on these important projects. This will soon become part of your habitual schedule and that job will get done over time by breaking these projects up into smaller blocks of time. The most productive writers often say that they sit down with their computer to write during a certain time of day, whether they feel like it or not, and much to their surprise they are able to make progress. Yes, this even works for the great story tellers of our time, such as Earnest Hemingway, who sat down every morning at the same time to write.

One of the best ways to become a time master is to understand your own biases, strengths and weakness about time management. Are you good at delegating tasks that can be performed by others? Do you lose track of time when you are interrupted in your office? There are tools that you can use to assess your time management skills, and help you work to develop better habits for improved productivity and better balance. As you begin to become more proficient in time management, you will find that your overall work place and life stress will also decrease, as you find more “time” to take on more of those projects that bring balance and joy into your work and life.

 

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-Dr. Deborah Sesok-Pizzini, MD, MBA is a Clinical Pathologist at the University of Pennsylvania, Perelman School of Medicine, who specializes in Blood Banking and Transfusion Medicine at the Children’s Hospital of Philadelphia.  She has a strong interest in resident leadership development, patient safety and quality, and is currently serving as a member on the ASCP Fellow Council.  She is a graduate of the ASCP leadership institute certification program and has an MBA from Villanova University with a concentration in finance.  

A Laboratory Professional’s Perspective on the Opioid Crisis

It was in the 1980s that physicians first explored the use of narcotics/opioids for the treatment of pain associated with non-terminal illnesses, including chronic and “mild to moderate” pain. In 2012, opioid prescriptions for outpatients were common, and some states had as many as 143 opioid prescriptions for every 100 people. Today, more than 6 out of 10 drug overdoses involve an opioid. The CDC states that 91 Americans die every day from an opioid overdose. This situation has been called “the opioid crisis” and the “opioid epidemic.” It is a public health emergency.

The landscape is characterized by new trends in both the drugs involved and drug user demographics. Current data indicates that prescription opioids are not the main problem. In fact, from 2015 to 2016, prescription opioid overdoses decreased from 17,539 to 16,800. The decrease in prescription overdose may indicate that efforts to reduce over-prescribing may be working. Or, drug users may be abandoning high cost prescription opioids for illicit drugs.

While prescription opioid overdoses have been decreasing, the incidence of heroin overdose has tripled. The incidence of fentanyl overdose has increased 196%, and the incidence of overdose due to non-methadone synthetic opioids has increased by 72%. Fentanyl is available both legally by prescription, and illegally from illicit sources. It is frequently combined with or sold as other drugs such as heroin, cocaine, and alprazolam. Fentanyl is 100 times more potent than morphine, and 50-100 times more potent than heroin. Even more dangerous are the fentanyl analogs, carfetanil(yl) sufentanil, acry and acetyl fentanyl, and furanyl fentanyl, to name a few. Sufentanil is 1000 times more potent than morphine, and carfentanil – sometimes called elephant tranquilizer – is 10,000 times more potent than morphine. Opioid abuse now spans nearly all demographics. In fact, NCHS Data Brief in 2017 disclosed that the age group with the most rapid rise in opioid overdose is adults ages 55-64 years. Some of the greatest increases in heroin related deaths have been among women, privately insured, and those with higher incomes – demographic groups that historically have had low rates of heroin abuse.

Laboratory professionals can help fight this crisis by providing relevant testing, and billing for the testing appropriately. Most hospitals are ill equipped to test for the synthetic opioid analogs. For many hospitals, the drug testing capabilities consists of an immunoassay based urine drug screen. These screens can detect many of the “classic” drugs of abuse like morphine (heroin), cocaine, amphetamines, PCP, and benzodiazepines. These screens do not differentiate individual drugs in a drug class, and they can’t detect fentanyl or fentanyl analogs, even with high degrees of cross-reactivity. As our Vice President of Laboratories expressed it to me, “our emergency rooms are full of overdose patients with negative drug screens.” Unfortunately, the culprit drug is not identified until a medical examiner orders forensic toxicology. More comprehensive and confirmatory testing like mass-spectrometry based testing provides more accurate information.

Mass spectrometers are not cheap, and many laboratory professionals are challenged with obtaining funding for them. The challenge is not lessened by the bad taste left in Medicaid’s mouth by code-stacking when billing for drug testing in the pain management patient population. This practice was, unfortunately, exploited by some physicians running office-based drug testing labs. Large multi-drug LCMS based panels were used in routine monitoring of pain management testing but instead of billing per panel, the test was billed by drug (analyte) in the panel. This practice led to CMS scrutinizing the use of mass spec testing alone and recommending the limited immunoassays. Laboratory professionals have the responsibility to advocate for the appropriate use of this powerful testing, and fortunately we are doing that – the Academy of AACC in collaboration with American Academy of Pain Medicine just released guidelines for the use of laboratory tests in monitoring pain management patients. We need to be trusted to do the right test, at the right time, for the right patient.

Forensic pathologists and toxicologists also face big challenges related to the opioid crisis. Forensic toxicologists are challenged to keep up analytically with synthetic and novel drugs entering the market while dealing with the pressure of limited budgets and client frustration with long turnaround times. Forensic pathologists are challenged by the sheer volume of overdose-related deaths. The National Academy of Medical Examiners (NAME) limits the number of autopsies to 325/pathologist/year. There are currently only around 500 board certified forensic pathologists in the US and the future doesn’t look great – only 3% of graduating medical students choose to enter pathology and only 7% of those will enter forensic pathology.

 

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Sarah Riley, PhD, DABCC, is an Assistant Professor of Pediatrics and Pathology and Immunology at Washington University in St. Louis School of Medicine. She is passionate about bringing the lab out of the basement and into the forefront of global health.  

New Year. New Skills.

I do not recall if it was an email or if I saw it on the ASCP website, but the byline caught my attention: New Year. New Skills. My mind quickly started racing. January marks a fresh beginning, the time to make new resolutions, the time to feel the excitement of new possibilities. 

The Issue

We are more than halfway through the month and I have yet to identify the skill I would next like to acquire. So many questions! So much to learn, so little time! How do you choose what to focus on? Where do you start? What can you manage? Is there anyone who can help or teach you? And if you are like me, you might also ask yourself, “Why do I always pile more on my plate?” Maybe this is the year you choose to learn to say no? Nah. So what’s it going to be?

The Solution

Since our lives are all different and there are millions of possible distinct scenarios, I will share what I decided to do. First, I evaluated my work-life balance and determined if I wanted to acquire a skill that would benefit my work (career and ambition) or lifestyle (health, pleasure, leisure, family) (1). I also took into consideration how much more I could fit onto my already overflowing plate.

I decided to work on something that would help me with both work and lifestyle (because who doesn’t like to maximize their return on investment?). I chose something I do not like to do, something that scares me, something I have difficulty with, something I avoid like the plague, but most importantly it’s something that I wish I could do better; a skill that I envy: having difficult conversations.

Communication is a vital component of our lives. We all communicate, but how many of us have mastered the skill of communicating? Also, there are many aspects of communication (2). Poor communication can make or break a situation or relationship. Being able to communicate well is a great skill to possess (3). Reference two provides a long list of skills that I highly recommend you also take a look at (https://www.thebalance.com/communication-skills-list-2063737). I went down the list and individually assessed which skills I feel that I do well with and which ones I do not (2). This little exercise served as a reality check as to where I stand in regard with my aptitude to communicate. I invite you to do the same. You may be surprised at what you find!

The Importance of Good Communication

As a laboratory director, many facets of my job depend on my ability to communicate well. I must communicate with clinicians, technologists, administrators, other coworkers, vendors, students, etc. Not only do I communicate with a variety of groups of people, in a multitude of different platforms (individually, small groups and meetings, or large groups; such as national conferences), but it is also important that my written, verbal, and non-verbal communication skills are clear and easily understood.

As laboratory professionals, one very important aspect of our job is to communicate critical results. It is essential that we not only relay the data, but it is equally important for us to communicate it well so that the clinician completely understands the information so that they can properly care for the patient. Moreover, we must not forget the golden rule: garbage in, garbage out. What I mean by this is that good communication should begin in the pre-analytical phase. We want the clinician to provide the laboratory with the best possible specimen so that in turn, we can provide them with the most accurate result. So how do we ensure that we obtain the best possible specimen? We communicate.

The laboratory communicates our needs to the provider in order to properly do our job. For example, we provide detailed information on how to properly collect specimens, which container type to use, how to handle the specimen, how much (volume) specimen to submit, which temperature to submit the specimen, etc. Properly communicating these details is essential.

The Difficult Conversation

As laboratory professionals, we are just one part of a larger healthcare team. If you stop to think about it, we all have to participate in difficult conversations as part of our jobs. Doctors have to tell patients that they are going to die, laboratory professionals have to tell clinicians we lost their specimen, executive administrators have to tell downstream leadership that the budget has been cut again, managers and supervisors have to tell employees they are being written up or worse. Being able to successfully have a difficult conversation would serve us all well. As such, most institutions provide classes or webinars to help employees develop this skill.

The definition of difficult is: not easily or readily done; requiring much labor, skill, or planning to be performed successfully; hard (4). Carrying out a difficult conversation with grace is an extraordinary skill that encompasses a variety of communication attributes. Regardless of the scenario, the communicator must be clear, articulate, and courteous. However, depending on the scenario, being concise, confident, strategic, diplomatic, convincing, empathetic, motivating, open-minded, and/or quick thinking may also be useful skills to possess during a difficult conversation. Other valuable skills are conflict management, being able to explain, and/or listening. 

The Conclusion

For many, the New Year marks the time to set new goals, to accept new challenges, and welcome new beginnings. Why not use this opportunity to learn a new skill? The good news is that no matter what your new skill will be, it will also benefit your health. In order to acquire a new ability, you must work to actively learn to become proficient in that ability; therefore learning a new skill will also benefit your brain function. There are many studies that demonstrate that active learning keeps the mind sharp (5). Challenging your mind improves brain function and active learning slows cognitive decline (6). If you want to be brave, then don’t only choose a skill that will be fun or helpful, but choose to learn something that also challenges you to face one of your fears. For me, I hope to learn how to master the art of having difficult conversations….successfully. In the words of Marie Curie, “Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.”

Happy learning! Happy New Year!

 

The References

  1. Work-life Balance. https://en.wikipedia.org/wiki/Work–life_balance. Accessed January 16, 2018.
  2. The balance. List of Communication Skills for Resumes. https://www.thebalance.com/communication-skills-list-2063737. Accessed January 16, 2018.
  3. The balance. Communication Skills for Workplace Success. https://www.thebalance.com/communication-skills-list-2063779. Accessed January, 16, 2018.
  4. com. Difficult. http://www.dictionary.com/browse/difficult. Accessed January 16, 2018.
  5. Stenger, M. 2013. New Study Shows How Active Learning Improve Cognitive Function. https://www.opencolleges.edu.au/informed/other/new-study-highlights-activities-to-improve-cognitive-function-6008/. Accessed January 17, 2018.
  6. Park, D.C., Bischof, G.N. 2013. The aging mind: neuroplasticity in response to cognitive training. Dialogues Clin Neurosci. 15(1): 109-119. PMC23576894. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3622463/. Accessed January 17, 2018.

 

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-Raquel Martinez, PhD, D(ABMM), was named an ASCP 40 Under Forty TOP FIVE honoree for 2017. She is one of two System Directors of Clinical and Molecular Microbiology at Geisinger Health System in Danville, Pennsylvania. Her research interests focus on infectious disease diagnostics, specifically rapid molecular technologies for the detection of bloodstream and respiratory virus infections, and antimicrobial resistance, with the overall goal to improve patient outcomes.

Organization Savvy

Understanding culture is essential to fit in anywhere: when you are traveling, with your family, and where you work. Understanding and appreciating culture is important, because you do not want to unintentionally offend someone by over-explaining a task, asking about personal lives when it is not considered appropriate, or going straight to business and skipping informalities completely when it is expected to get to know each other before attending to tasks at hand. Understanding organizational culture is therefore important for every employee. However, creating a fostering a productive culture is the responsibility of the leaders.

There is a critical distinction between the culture and the climate of an organization. Culture refers to how employees feel they are expected to do things and behave. Climate is the causal factors of the culture. Another way of putting it is that culture reflects the shared values, beliefs, norms, and expectations; climate reflects the outcomes of the culture such as engagement, teamwork, and perceived quality of work. However, it is important to note that there are two levels of culture: the ideal culture, or what should be expected; and the current culture, or what is actually expected. If we compare the climate to the human body, climate is the pulse, temperature, and blood pressure. Culture would be the bigger medical issues such as flu or cancer. The ideal culture would be a cancer-free body, while the current culture might be a body with a cancerous tumor caused by the climate of smoking. This example shows that culture is harder to change than climate: it is easier to change someone’s blood pressure than to change their cancer status.

Climate can therefore also drive and change the culture. If you want to change something in the culture, you can start with changing the climate. Let’s take the following organization as an example in which the ideal culture is that team work is valued, but the current culture shows that competitiveness is valued. The causal climate factors are in the structure of performance reviews: only individual and competitive behavior is analyzed, but not team behavior. If we would thus change the structure of the performance review (climate) we could change the current culture (competitiveness) closer to the ideal culture (teamwork).

The Organizational Savvy course focuses on how you see the current culture of your organization. It organizes the culture in three different clusters: constructive, passive/defensive, and aggressive/defensive. Each of these clusters are then divided into four styles, allowing you to understand your culture in more detail. The course explains how to improve the culture of the organization based on the profile.

Understanding what is expected in your organization sets you up for professional success and allows you to be an active member of establishing effective organizational culture. Whether you are a leader, chair, employee, or staff member, taking proactive steps to understand and foster organizational success will set you and the rest of your team and organization up for prosperity.

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-Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. She’s currently working toward a PhD in Organizational Leadership. At ASCP, Lotte designs and facilitates the ASCP Leadership Institute, an online leadership certificate program. She has also built ASCP’s first patient ambassador program, called Patient Champions, which leverages patient stories as they relate to the value of the lab.


 

Organization Savvy is the core of high-performing organizations. It is a mixture of staff’s emotional intelligence, interpersonal relations, skills, self-awareness, competencies, and optimized organizational culture. With my experience in centralized laboratory services, improving quality in thirty laboratories with a wide variety of organizational cultures was a big challenge. To enhance the best practices and empower quality improvement projects, organizational savvy is required. The best tools to achieve this were creating an organizational influence map, building relationships with different laboratory staff, influencing people by turning the organization into learning atmosphere, and the most important, avoid negative players.

With my journey towards excellence, I had to communicate with different leadership styles. I had great outcomes with constructive style leaders, as they are task- and people-oriented, collaborative, achievers, humanistic, and encouraging. I had some difficult times with aggressive/defensive leaders who have some insecurities. I had to assure them that our journey towards excellence is to build people before building the organization. In addition, they had to realize our organizational objectives were in full alignment with their core values and career goals. I worked on improving my personal power by using self-awareness assessments and improving emotional intelligence. My skills and knowledge in Quality of Laboratory Medicine were good enough to build credibility inside the organization. My future goal is to increase my circle of influence and reduce my circle of concerns to achieve organizational savvy and hence, the organizational vision towards excellence.

 

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-Dr. Rana Nabulsi has a PhD in Quality Management and a master’s degree in molecular genetics. She is currently the Head of Quality at Pathology and Genetics department at Dubai Health Authority and the Chair of Advisory Board at the American Society for Clinical Pathology (ASCP) in UAE. She is doing her fellow at the American Collage of Healthcare Executives (ACHE). She is a Certified Professional in Healthcare Quality (CPHQ) by the National Association of Healthcare Quality (NAHQ)-US and certified for Green Belt -Six Sigma (SSGB) by the American Society of Quality (ASQ). Dr. Nabulsi has experience in leading more than twenty medical laboratories in achieving the College of American Pathologist (CAP), ISO 15189, and American Association of Blood Bank (AABB) accreditations. She is certified as lead auditor for ISO 9001, ISO 15189, ISO17025, and OHSAS 18001 management systems. Dr. Nabulsi is a certified EFQM Assessor, trainer and public speaker for local and International Healthcare conferences about healthcare quality, safety, and leadership.

 

Safety Motivation

If you search for top motivational movie speeches, you will see things that might work in real life. The President’s speech from Independence Day (1996), for example, might influence you to never be oppressed by alien tyranny. Freedom will be your rally cry after listening to William Wallace in Braveheart (1995), or Maximus from Gladiator (2000) can speak to your heart about teamwork. Unfortunately, such speeches do to tend to maintain motivation for great lengths of time. Also, none of them will translate to a motivational discussion about safety with your lab staff.

Over many years I have watched what motivates people to do the right thing or take the safe actions in the laboratory, and that motivation varies. Different groups of people are persuaded by different forces, and understanding that can help you move your lab safety culture in the direction you desire. You may not agree with or even like some of the influencers, but learning them can help you be more effective in achieving overall safety compliance.

They say money is a motivator for people in all kinds of circumstances, and that’s true for lab safety as well, although not in the way you might believe (while some businesses may pay a bonus for fewer safety incidents, that is not typical in the lab setting). Lab staff who are concerned about finances are more open to following some lab safety practices if they realize the cost savings. Obviously, lab injuries and exposures cost the department both monetarily and with staff absences. Following proper regulations can reduce costly citations and fines that can be levied by organizations like OSHA, the EPA, or CMS. Some lab team members want funds available for new equipment or more staff. Use that to encourage them to follow proper safety procedures. Make sure staff properly segregates waste in the lab, for example, since doing things like placing paper into a sharps container costs the department extra money. Hospital and lab leadership also respond well to financial motivation. If you need something fixed or replaced because it is unsafe, always explain the financial consequences to the facility if the fix is not approved.

Knowledge can also be a powerful safety stimulator for some staff. Understanding the consequences of poor safety behaviors will discourage some, and education about those consequences needs to be given regularly. Let’s look at waste disposal again- those who are concerned about the environment should know that tossing clean items into a biohazard container could increase the need for biohazard landfills in the area- something we should avoid. Talking about the follow up testing and unpleasant effects of prophylaxis following an exposure from an unknown source can be very eye-opening. It may spur staff to be more careful when potential exposure situations arise.

You might not like to hear that punishment can be a motivator for correct behaviors, but for some staff members it is. Sometimes, explaining that a written corrective counseling or even termination will occur if safety practices are not followed will keep laboratorians working carefully and correctly. No one wants to “threaten” people to do the right things, but there will be those who are only motivated by not wanting to “get in trouble.” Knowing who those employees are can be important to guiding your leadership approach when working with them.

Lastly, some lab staff are inspired to act safely because the environment is designed to make doing so easy. PPE is readily available- lab coats of all sizes are accessible, gloves are out and not in a drawer, and face protection is mounted conveniently. There are hooks for lab coats near exit doors and hand washing sinks so that staff can properly doff and exit. Cleaning supplies and spill kits are readily available and instructions to use them are posted and up to date. Warning signs are there for staff and for visitors not used to the dangers in the department. I know that many labs are older, and the physical layout is not always conducive to making safety easy, but there are always steps that can be taken in order to make safety easier to achieve. You may need to step back and look at your environment with fresh eyes in order to envision what can be done to make improvements.

Think about what incentives are important to you when it comes to lab safety. Is it simply self-preservation? That’s good, but for many who are complacent about safety, their motivation may be different. Finding their reasons to be safe is a worthwhile task. It helps you understand better who your staff is as a people, and it will help you gain expertise for providing the stimuli they need to continue to work safely today and every day.

 

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Dan Scungio, MT(ASCP), SLS, CQA (ASQ) has over 25 years experience as a certified medical technologist. Today he is the Laboratory Safety Officer for Sentara Healthcare, a system of seven hospitals and over 20 laboratories and draw sites in the Tidewater area of Virginia. He is also known as Dan the Lab Safety Man, a lab safety consultant, educator, and trainer.

Patients and Patience

Holiday season is around the corner! And, as such, I’d like to take this opportunity to share a few thoughts I have on how our professional scope as laboratorians extends all the way from the bench to the dinner table.

How many times have you been asked by friends and family what it is exactly you “do” at work? And how many times have you done your best to explain, being met with references to unrealistic television shows or generalizations that go beyond your scope of practice? It’s happened to me a million times. It’s the nature of our laboratory culture. It’s a vital role in patient outcomes, but often behind the scenes. But just for a moment, let’s say you get beyond those surface explanations—what happens next? Probably, in most cases, not much.

One of the main tenets of the ASCP mission which we all work together is advocacy: for our communities, our institutions, our teams, and our patients. More often than not I would bet that family members venture into that turnpike, mostly as patients. When a grandparent, uncle, sister, or friend says they’ve got an upcoming procedure or test, how many of us would share our knowledge with him or her? I know I would. Not in a way that goes beyond our scopes as phlebotomists, medical laboratory scientists, or cytotechnologists, or medical students, or pathologists—but as someone who wants to empower their loved one to be the most informed and prepared patient they can be. In 2012, the Agency for Healthcare Research and Quality (AHRQ) promoted their campaign “Questions to Ask Your Doctor.” In it, they cite that good health depends on good communication and that patients should not be afraid to ask their physician questions about their health outcomes. You remember, the commercials with the guy at the cell phone store that asked a hundred free train-of-thought questions but was speechless in front of his doctor…I loved those.

In that same holiday spirit that celebrates thankfulness, family, and relationships, let’s include laboratory professionals! If you have a loved one who it applies to, explain just what happens after those six different colored tubes were drawn, explain how that removed mole was set, sectioned, and reviewed, explain how staining different cells in a body fluid give a clinician important data about their health. Hundreds of thousands of laboratory professionals in the United States could offer not just invaluable information to their friends and family, but peace of mind. Demystifying the medical process might make those patience more confident in asking informed questions and, together with their provider, improve their health outcomes.

I find myself in an interesting position today. Having years of explaining what CBCs or CMPs actually measure and why someone might have to fast before a lipid panel, I’ve started a slow transition to learning how to explain what that means to an individual’s health. What a fantastic foundation lab medicine gave me to build on! (Really a recurring theme you’ll see in lots of my posts.) By moving from what different stains mean to a clinician, I am now on a path toward being able to use that information for the next step in professional scope: diagnosis and management.

Just like I’m on this academic and professional journey, lots of us are on a path through or toward something. But back to our ASCP message, advocacy for patients means recognizing their journey—especially when they’re our family and friends. The best outcomes for any patients rely on valuable information, communication, and rapport. And while you help your loved ones through the steps of their journey as a patient you might empower them to be a more involved member of their healthcare team. As a result, they might experience more personal and effective care. And a bonus just for us: maybe more people would appreciate some behind the scenes lab medicine. Who knows?

So, from me and mine to you and yours, have a great holiday season and a wonderful new year! I’ll return with stories, cases, and commentary on medical school clinicals in January!

Take care and thanks for reading!

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Telemicroscopy: Applying Technology to Solve an Old Problem

The Gram Stain

Everyone knows that the Gram stain is an essential microbiological method which aids in the differentiation of bacteria. When a specimen is sent to the clinical microbiology laboratory for culture, the Gram stain result is frequently the first information provided to the clinician. It is used to first determine a) if infection is present and b) what type of infection (i.e., gram positive vs. gram negative? monomicrobial vs. polymicrobial?). Furthermore, if organisms are observed in a normally sterile fluid/tissue (i.e., blood, cerebral spinal, fluid, cardiac tissue, etc.) the Gram stain result can be a critical result. More importantly, the Gram stain result often drives patient care. 

The Issue

Although the Gram stain is an essential clinical tool, many laboratories struggle to maintain competent technologists, especially on off-shifts or in laboratories that lack microbiology expertise (generalists). The need for second review is common when performing Gram stains as they are often subject to variability due to inconsistent staining techniques, antibiotic pressure, as well as artifacts. Even under best case scenarios, Gram stain interpretation can be challenging and may require multiple reviewers. 

The Solution

Telemicroscopy offers an easy to use and relatively inexpensive solution to provide formal and informal second opinions to various sections of the laboratory (microbiology, hematology, pathology). With the proper tools, telemicroscopy allows Gram stain interpretation from anywhere there is internet access.  Every hospital laboratory has a microscope and a computer with internet, so the only item that may need to be purchased is a microscope camera (≥$5,000). There are also various microscope adapters available for phone cameras that provide equal results for less capital (≥$90). The microscope adapter encases the smart phone and then fits into the eyepiece of most microscopes.

Telemicroscopy utilizes technology to improve diagnostic accuracy, by providing expert consultation for technologists who are uncertain of their results. Telemicroscopy allows laboratories to “present” still or live images to a reference laboratory via a web-based software application such as Skype (or FaceTime if using an iPhone).

About Geisinger Medical Laboratories Telemicroscopy Program 

Geisinger Medical Laboratories is an eight hospital integrated health service organization, serving >2.6 million residents throughout 46 counties in Pennsylvania. Geisinger Medical Center serves as the reference laboratory for 4 minimal laboratories (Gram stain reading, no culture work-up) and 2 partial laboratories (Gram stain reading, limited culture work-up). The Telemicroscopy program consists of presenting still or live images [Olympus BX40, BX41 microscope, Nikon cellSense software (version 1.7.1)] to the reference laboratory via Skype [Logitech 920 camera (version 2013)]. The telemicroscopy result, which is a consensus finding, is manually recorded and followed up with culture review to determine patient impact. 

The Outcome

We evaluated the effect of implementing a telemicroscopy program on patient care.  A retrospective look back at our telemicroscopy data showed that nearly 40% of consults resulted in a change to the original interpretation. The consensus Gram stain result correlated with culture 85% of the time. Overall, 49% of the cases assessed by telemicroscopy were impacted by the consult. Of which, patient care was positively and negatively impacted in 72% and 28% of cases, respectively.

The Conclusion

Gram stain consultations via telemicroscopy from remote hospital sites can improve patient care. Telemicroscopy offers a simple, inexpensive, and innovative approach to providing expert consultation services to off-shift or inexperienced staff. This is also a great way to promote interdepartmental consultation and collaboration (i.e., between microbiology and hematology or pathology).

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Image 1. Telemicroscopy via traditional microscope camera. Microscope with camera attached and computer screen showing Gram stain.
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Image 2. Telemicroscopy via s mart phone. Close up of microscope adapter attached to microscope. Image of Gram stain displayed on phone screen.

References:

  1. Microbiology Strong: Enhancing Microbiology Services and Technical Support in an Integrated Laboratory System. ASCP.  Las Vegas, Nevada. September 2016. Oral presentation.
  2. Martinez, R.M., Shoemaker, B.C., Riley, J.A., and Wolk, D.M. 2016. The TeleGram of the 21st Century: the Digital Gram Stain. American Society for Microbiology (ASM) General Meeting. Boston, MA. Poster presentation.

 

Martinez Headshot-small 2017

-Raquel Martinez, PhD, D(ABMM), was named an ASCP 40 Under Forty TOP FIVE honoree for 2017. She is one of two System Directors of Clinical and Molecular Microbiology at Geisinger Health System in Danville, Pennsylvania. Her research interests focus on infectious disease diagnostics, specifically rapid molecular technologies for the detection of bloodstream and respiratory virus infections, and antimicrobial resistance, with the overall goal to improve patient outcomes.