Meet the Medical Technologist Who Does Daily Rounds in the Hospital

Participating on patient rounds each morning allows lab team to contribute to better patient care

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TO MAKE THE TRANSITION FROM VOLUME TO VALUE, pathologists and clinical laboratory scientists are beginning to leave the four walls of their labs to engage clinicians in ways that add value to the lab tests performed on their patients.

That’s exactly what one medical technologist is doing in a community hospital in the Midwest. Daily, she leaves the lab and makes rounds with the hospital staff.

This is a twist on the oft-stated fact that pathologists are the “doctor’s doctor.” It is more common for pathologists to consult with physicians in the selection of the most appropriate lab tests, then help with interpreting the lab results to identify the best therapies for those patients.

Med Tech Joined rounds

In April, this med tech joined the daily rounds at Putnam County Hospital. Christina L. Bard, CLS (ASCP), MBA, the Laboratory Manager at the hospital, is part of the team making rounds that includes physicians, nursing leadership, and other clinicians, at the 25-bed critical access hospital in rural Greencastle, Ind. The laboratory has a staff of 18 who run about 150,000 billable tests each year.

Despite its size, the clinical lab plays a vitally important role in improving patient care. This comes, first, as a direct result of having Bard and other lab leaders participate on patient rounds and, second, because the lab team facilitates communication among all hospital staff.

Like many of the nation’s critical access facilities, Putnam County Hospital is too small to have a full-time pathologist on staff. “We have a pathologist who comes here for eight hours a week,” Bard explained. “It means the physician’s physician is not on-site every day. That is why it made sense for the lab leadership team to go on the daily rounds. Typically rounds start at 10:30 am in the ICU.

Improving patient Care

“This spring, the hospital engaged nursing leadership in a program that involves patient rounding every day,” she said. “The lab answers through the organization to the chief nursing officer. One day we got a note from her that requested participation by the nurse managers.

“When she sent this email encouraging her nurse managers to participate, I thought, ‘I’m also going on rounds because I’m part of the patient care team!’” stated Bard. At that point, she realized the importance of having a professional from the clinical laboratory among those rounding with physicians.

“After the first day, I told the nursing manager that I was the only member of the team who was not a nurse or therapist. I asked if she had a problem with that,” Bard said. “‘Not at all,’ she told me. ‘Sometimes we have lab questions and so it’s good to have you there.’

“As a result, my participation created a huge opportunity for us in the lab to build relationships that we might not have otherwise and to partner with those on the patient care teams,” she noted. “In fact, we’ve brought much value. The care of specific patients has changed based on the information we bring during rounds.

Laboratory Manager Offers Advice Based On Her Experience Doing Daily Rounds with Clinical Team

WHEN ANOTHER MEMBER OF THE laboratory staff needs to do rounds, Laboratory Manager Christina L. Bard, CLS (ASCP), MBA, has prepared the following suggestions.

Things to DO During Rounding

  • Print (or access) patient census review admitting diagnosis and current working diagnosis.
  • Review patient results prior to rounding.
  • Review critical results – was a repeat test ordered after treatment interventions?
  • Example of critical alcohol: was a repeat value after time/therapy performed?
  • Compare diagnosis against lab tests ordered to ensure they are appropriate.
  • Example of chest pain diagnosis: was a Troponin ordered x3 Q 6?
  • Compare diagnosis against lab tests ordered to ensure they are appropriate.
  • Example of chest pain diagnosis: was a Troponin ordered x3 Q 6?
  • Review the last two times a laboratory test was performed to look for changes in the patient’s status.
  • Example: Yesterday and today’s H&H results: was there a change? If so, was the patient transfused, taken to surgery, etc.?
  • For patients with an infection, review any culture results for the entire visit, not just the last 24 hours.
  • Compare culture susceptibilities against antibiotics given or, if a pharmacist is on the rounding team, take the report for him/her to review.

Things to AVOID During Rounding

  • Do not arrive late.
  • Avoid unnecessary, non-clinical comments about a patient or patient’s family. Be respectful as you do not know who is listening and who might be related to the patient.

Fostering Communication

“Three examples paint the picture of our role,” Bard commented. “In the first week, the physician and nurses were looking at a particular patient’s lab results and talking about how the patient had shortness of breath. During the discussion, it became apparent that there were other values that are relevant to the patient’s treatment. I spoke up to say that the patient’s blood work showed her mean corpuscular volume was over 100, which means she had macrocytic anemia. She didn’t need iron; she needed vitamin B and folic acid.

“Following that episode, our ICU nurse manager contacted me in the following week to say she was planning her monthly staff meeting and asked if someone from the lab could do a 15-minute educational session on anemia,” explained Bard. “As a result of that one meeting, I am on the nursing agenda for their monthly meetings to present relevant lab topics that help the nurses take better care of their patients.

“At that first session with the nursing staff, I explained why a patient with low hemoglobin doesn’t necessarily need a transfusion. Nor does it mean the patient needs iron,” she said. “I explained which lab tests are appropriate in this situation. It was a short presentation of 15 or so slides, which I left behind for them as a handout.

“Here’s example number two,” continued Bard. “Transitions of care are a challenge in every healthcare facility. A urinalysis was done for an ER patient. Based on those results, it was determined that the patient needed a urine culture. The patient has several other health issues and concerns. Because of all those problems, she was admitted to the ICU.

“Two days later, when the urine culture came back, the result was positive for an infection and I saw what the organism was,” recalled Bard. “During rounds the next day, they were discussing how the patient’s glucose was still high and she was still out of it. They were still treating the diabetes.

“I happened to have the urine culture results with me, and when I showed them to the physician that day, he prescribed an antibiotic,” she said. “This is a good example of where the lab intervened to improve patient care.

“The fact that the patient had an infection was easy to miss,” she added. “Thus, having someone from the lab at the rounding huddle during the discussion helped that patient get the care she needed.

“Here’s the third example. For inpatients, a set of labs gets ordered every day,” observed Bard. “One afternoon, a newly-admitted patient had a full CBC done. For that patient, the test generated results for hemoglobin, hematocrit, the white blood count, and the red blood count. At 6 pm on that patient’s first night, all of those levels were slightly decreased but not enough that the patient needed a transfusion.

Need for Transfusion?

“The next morning, the patient’s hemoglobin had dropped two full grams, which is a significant decline,” recalled Bard. “She had gone from about a nine or 10 down to seven or eight. The nurse and the doctor reviewing the results were alarmed and thought they needed to transfuse.”

During the discussion, the patient’s fluids were reviewed. Because the fluids were running at a high rate, it was suggested that this could be affecting the lab values. “Hearing that, I suggested that we should turn the IV off,” Bard added. “I also suggested we do a re-collect, and then recheck the results. It turned out that the patient did not need a transfusion at all.

“Having such successes during daily rounds has led to better interactions between the lab and members of the direct patient care team members,” she stated. “This has been noticed by many people in the hospital. We now have one physician who calls the lab to ask us about which tests he should order for certain patients.

“What is noteworthy in our experience is that we achieved this success after spending only about 30 minutes per day on the actual rounding,” offered Bard. “There is some preparation that’s required before rounds begin.

“First thing every morning, I print a census and pull up each patients’ results,” she said. “I quickly review them before the rounds begin. In total, it takes probably 45 minutes to an hour for both the pre-rounds review and participation in each day’s patient rounding.

“Our lab has always been responsive to physicians’ needs and I don’t think we’re any more responsive now that we are a part of the rounding team,” Bard added. “Having a laboratorian at rounding is a resource for care providers to ask questions about results or what appropriate test to order. In return, this provides our patients with the best possible care.

“The big difference since the lab leaders joined daily rounding is that there is much greater awareness among physicians and nurses about the vast knowledge our lab has that relates to direct patient care,” concluded Bard. “Participation in daily rounding demonstrates the extra value that the laboratory team provides when we partner with our clinical colleagues.”

Contact Christina Bard at 765-655-2607 or tbard@pchosp.org.

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