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Territorial battles and turf wars in the cardiovascular arena are the stuff of legend. Radiologists pert formed interventions in radiology suites, vascular surgeons repaired abdominal aortic aneurysms in the operating [...]

Change is the key word at Sarasota Memorial Hospital & Healthcare System's (SMH's) laboratories. The sentiment is reflected in a colorful "Who Moved My Cheese?" poster on Anne Beall's door. [...]

Point-of-care testing has not spread as aggressively through the British hospital system as it has in the United States. The United Kingdom's National Health Service is slow to make changes and laboratories are resistant to decentralization. Where point-of-care testing is used is poorly regulated and there is no quality control in place.

Critical care nurses and hospital laboratories should work together to create a point-of-care testing system. A point-of-care system often creates more work for nurses, but gets them the results they need. It is the laboratory's responsibility to maintain equipment and monitor results for quality.

Before implementing a point-of -care testing program, hospitals should determine do a cost-benefit analysis and and learn regulations and licensing requirements. Personnel who will be performing the tests should be trained and tested for competency. Once in place quality of work, efficiency and record keeping should be examined.

Practicing clinical laboratory medicine in rural areas has its own advantages and disadvantages. Problems in staffing, equipment maintenance, isolation from other health facilities and stocking of sufficient blood supply are some of the serious considerations in rural hospital laboratories. However, exploiting local talents and resources can eliminate problems in these areas. Moreover, these limitations pose challenges to the practitioners. Using one's ingenuity and self-reliance increases the satisfaction one gets from work., Laboratories in sparsely populated pockets of the world, from the spacecraft Challenger to our modest medical center in Plattsburgh, NY, employ talented individuals to work in physically demanding environments. Rural [...]

Hospitals in Ontario depend largely on transfer payments from the provincial government for their finances. Ontario hospitals trail their US counterparts and private laboratories in Canada in initiating reforms and implementing cost-cutting measures because of budgetary constraints. Ontario hospitals have begun restructuring their laboratories. The restructuring includes delayering of management, transforming divisions into a core laboratory, consolidation of workstations and analyzers, workflow engineering and cross-training of technologists., Hospitals in Ontario are almost completely dependent for their finances on transfer payments from the provincial government. Before the late 1980s, public funding for hospitals was fairly stable. For several [...]

Hospital laboratories continue to investigate new ways of improving Stat testing and its turnaround time. According to a national survey of medical technologists, there are several steps that could possibly enhance Stat testing. These include reviewing Stat policies, installing a pneumatic tube system or new instrumentation, redesigning the laboratory's physical layout, upgrading the computer system and personnel training. Some 43% of respondents reported that their labs use hand-held point-of-care technology., Laboratorians continue trying to improve Stat turnaround time and reduce Star abuse. From MLO's latest survey, here's a look at initiatives that have and haven't worked. STAT TESTING PROVIDES some [...]

About 53% of hospital laboratorians believe that Stat testing is a problem. This was revealed in a nationwide survey of 1,030 medical technologists. The survey also found that 93% of the laboratorians who believe that Stat tests are a problem also consider Stat testing to be abused, primarily by doctors and nurses. Overall, however, 91% said that their laboratory has not needed to add new personnel to cope with the growing volume of Stat tests., More than half (53%) of respondents consider Stat tests a problem. That's one of the findings from MLO's latest national survey on what some regard as a "no win" situation. [...]

Regional integration and coordination is proving to be a viable alternative to hospital laboratory cost cutting. Practical models of regional laboratory operations are referral models and networks. The former includes barter arrangements, single hospital with outreach, regional referral models, off-site core model, on-site core model and mosaic model. Networks, or regional cooperative models, differ from referral models in that the relationship between core and regional labs is interactive., Lacking standardized information, each lab consortium that has sprouted has tended to reinvent the wheel. When pondering a regional network, consider these examples of what has worked for others. Final [...]

A not-for-profit health service facility reported success in adopting the total quality management (TQM) principles to decrease its high blood culture contamination rate problem. The laboratory quality assurance committee identified the phlebotomists as a major source of contamination. The use of TQM's nonthreatening approach encouraged the phlebotomists to undergo in-service training, share their work experience and to eventually improve their performance. The facility eventually solved its problem and was able to maintain a contamination rate that was 3% lower than the accepted threshold., The tools of TQM--team building, group problem solving, data-driven decision making, and positive feedback--worked to reverse a blood culture contamination rate in excess of 3%. HEALTH CARE ORGANIZATIONS--partially at the [...]

Optimizing antibiotic therapy and antibiotic stewardship is a mantra often chanted, yet together they seldom get the necessary recognition as a common denominator that mutually impacts departments hospital-wide. Unfortunately, laboratories [...]

If time is money, as the saying goes, then hospital laboratories and the managers that oversee them are in crisis. They face ever-mounting pressure from clinical departments to deliver patient [...]

The author's research and enterprise in ordering tests from referral labs have delighted doctors and expanded test volume. Seven years ago, when my children were entering school, I decided to [...]

In this three-part series, the author supports extensive send-outs in a myriad of situations. This month: how to determine whether it would be wise to do that new assay in-house. [...]

The cycle of testing in the clinical laboratory is a loop. It opens with a test order placed by a physician and closes with the presentation of the result. Many [...]

Laboratories today can expand and diversify as never before beyond their traditional services. Advancing technologies continuously produce new tests not only for the sick but also for the healthy and [...]

Instrument systems and analytical methods for clinical diagnostics must provide accuracy and precision, speed and convenience for the quantification of specific molecular and particulate species, ideally with no or minimum [...]

In 1993, The Medical University of South Carolina (MUSC) in Charleston undertook a change management initiative to achieve a more cost-competitive position in its market and become a more attractive [...]

The Swedish American Hospital adopted a total quality management program to improve the process of intradepartmental problem solving. The Rockford, IL-based, 400-bed, full-service, acute care center established a morning shift phlebotomy team, acquired a new chemistry analyzer and installed a pneumatic tube system. The changes improved laboratory turnaround time, shift cooperation and instrument applications., A phlebotomy team, a tube system, a new chemistry analyzer, and end-of-shift maintenance and QC made all the difference in this hospital lab's chemistry turnaround time. To operate a customer-focused [...]

Several questions on the management of medical laboratories are answered. The questions pertain to steps on handling a laboratory manager's crude behavior, inculcating a sense of safety among laboratory staff, and the 1988 Clinical Laboratory Improvement Amendments's provisions for recertification of procedures and equipment. Other topics which are clarified include the updating of hematology reference intervals, and fluid processing and diluting., Technologist troubled over manager's clowning around Q Our lab manager loves to indulge in practical jokes and horseplay during work hours. While our staff doesn't seem to mind his crude [...]

Microbiology laboratories are restructuring their management operations to improve turnaround time. New ground rules have to be established to maximize the time of physicians, technicians and laboratorians. A new shifting policy has to be created to maximize man hours and improve microbiology bench work, which can be done by rotating the schedules of the medical technologists. Turnaround time can also improved by using a more efficient documentation system., What happens when a customer wants something that seems difficult, if not impossible, to provide? Sometimes before solutions surface, everyone must be willing to change the status quo. CENTRAL DUPAGE [...]

Advanced technology has enable bedside testing techniques to be more efficient, faster and easier to use. Decentralized testing allows examination of a number of analytes using small and portable equipments. However, various professional organizations recommend several guidelines to regulate the use of decentralized laboratory testing for more effective management and organization of bedside testing programs., From oral alcohol to transcutaneous p|O.sub.2~, more than a dozen analytes can now be measured at the point of care. AS EARLY AS the 19th century, tedious and time-consuming laboratory [...]

After logging in 12 years of experience throughout the clinical laboratory, I was a seriously bored medical technologist. Filling a newly created slot as head of the development lab within [...]

Emergencies can paralyze a lab and shatter customer confidence. Good managers develop coping mechanisms early. Would you be prepared if: [paragraph] A routine crossmatch were badly botched, resulting in the [...]

Effective ways to deflect hostility Have you ever answered the telephone in your laboratory only to get an earful from an irate caller? Had that caller ever screamed and carried [...]

Self-scheduling can increase job satisfaction The idea of self-scheduling conjures up images of organizational chaos characterized by crowded day shifts and an empty laboratory at night and on weekends. Untrue. [...]

Pathology, microbiology, blood bank and other diagnostic laboratories generate sizable amount of biomedical waste (BMW). The audit of the BMW is required for planning proper strategies. The audit in our [...]

The recent publication of the Institute of Medicine (IOM) report on medical errors has once again raised the issue of quality of care in the health professions (Kohn, Corrigan, and [...]

Here's how 2 Ontario hospital laboratories and their staff members got a crash course in consolidation--and survived the transition without slighting patient care. In the past decade, consolidation of laboratory [...]

Plan, prepare for disasters Q I recently moved to Florida, an area that has had a few close calls (and direct hits) with some scary storms. What do you suggest [...]

At $6 million, Stephane Bouchard's 2-bedroom apartment is a little on the pricey side, especially considering the place is overrun with giant spiders. However, it does have hardwood floors. Even [...]

Q I believe our lab's unionization is the root of most of our management problems. A woman on my staff has been here 18 years. I am at my wits' [...]

As laboratory manager at Nebraska's Columbus Community Hospital (CCH), it is incumbent upon me to strike a critical balance between building upon my staff's expertise and advantageously utilizing the technology [...]

Hiding behind voice mail Q: One of the department heads at our reference laboratory facility hides behind her voice mail. She never answers her phone calls as they come in, [...]

Lab directors seek adequate resources to do their job, and administrators seek support in expanding hospital business while holding down costs. The author, a member of MLO's Editorial Advisory Board, [...]

Management at all levels must cooperate in dealing with the impact of economics, new technology, and quality assurance. The author, a member of MLO's Editorial Advisory Board, is vice president [...]

Anatomy of a lab transition: Retaking in-house control In 1973, Hahnemann University Hospital became the first university medical center to have a reference lab run its clinical laboratories. Thirteen years [...]

Reducing blood outdating: An incentive program saves a shrinking resource In 1985, the transfusion service at our 700-bed tertiary-care hospital received a challenge from its blood supplier: If blood outdating [...]