If you’ve ever had to wait on lab results from a test your doctor has ordered, you’ve probably not thought much about what happens behind the scenes before those results are sent back to your doctor.
Between April 22 and 28 this year, medical laboratories around the country are celebrating “Medical Laboratory Professionals Week” to recognize the vital role lab professionals play in ensuring high-quality, trustworthy health care for patients. As part of this celebration, Springfield Clinic wants to bring awareness to its own lab sites and the technologists and phlebotomists that work at them. It’s important to recognize Springfield Clinic lab professionals because they do quick, efficient and accurate work and help support the diagnoses doctors make every day.
When Laboratory Director Tina Walke started at Springfield Clinic 28 years ago, Springfield Clinic labs looked much different than they do now. There were only a few lab locations, and lab work wasn’t yet computerized; up until 1997, all work was done completely on paper and put into hard copy records. “It was good for me to start when I did,” Tina says, “because I started right at the point that Springfield Clinic was really starting to grow and expand. I was able to grow with it.”
After computerization took effect in 1997, it was still a little over a decade before the rest of Springfield Clinic fully computerized and adopted the electronic health record in 2008. Once the whole organization switched to computerized recording, the model of the lab changed too. Before, lab technologists were spread out all over Springfield Clinic sites; because things were recorded and kept on paper, it was more efficient to have an on-site technologist for each doctor’s office. After implementation of the electronic health record, however, Tina was able to move her technologists to a more centralized location, which made the team more efficient.
“Now, we’re a network of 34 locations,” Tina says. “And every single one of those 34 sites has to meet regulatory requirements.” Every Springfield Clinic lab site is “inspection ready” at all times, which means any Springfield Clinic lab manager, accrediting agency or regulatory agency can do an inspection visit at any moment. Each of those sites also has a separate CLIA (Clinical Laboratory Improvement Amendments) license that has to be maintained. Just because the Main Campus lab passes accreditation or licensure doesn’t mean every satellite lab is good to go—Every site must be held at the same high standard. That way, patients can be assured there are qualified people drawing blood or doing testing in a safe, clean environment. If a lab didn’t pass inspection and was closed, Tina says, some Springfield Clinic patients might have to travel farther to have samples drawn. It’s important to Tina and her technologists to keep all of the lab locations open so patients have easy access to quality lab work.
The machines and test methods themselves also have to be tested every single day. Tina and her technologists enroll in blind samples, where an agency will send a random sample to be tested. A technologist must test the sample and send the results back, which are graded to see if they are within an “acceptable” range of answers. Similarly, all of the analyzers are tested every day with control samples and sometimes several times a day to make sure they are reporting accurately. (“Control samples” are samples where certain values are known, and a technologist can determine if an analyzer is working properly if it finds the values it’s supposed to.)
Tina holds her technologists to similarly high standards: Every Springfield Clinic technologist has a four-year degree in clinical laboratory science, a degree that is more specific than a general biology or chemistry degree. Although technologists are not licensed by the state, they have all passed a separate certification examination. To maintain this certification, they must have 12 hours of continuing education each year.
Along with meeting rigorous standards for the lab professionals and the test methods they use, Springfield Clinic labs strive to stay on the cutting edge when it comes to technology. Besides leading the way in computerization for the organization as a whole, the biggest change for the labs since Tina started in 1990 is the use of “autoverification.”
Some of the labs’ high-volume analyzers are programmed by technologists to scan results in certain tests for abnormalities. If everything is normal, the machine can release the results immediately to the electronic health record, leaving the technologists more time to spend on abnormal test results. “Technology has made a big difference in time and efficiency,” Main Campus Lab Manager Joe Heigert says. “The instruments have become more sensitive. We can have one tech do 900 samples in a day whereas years ago, you would have had two or three techs doing that.”
Tina agrees: “The analyzers are getting faster and more efficient, and we’re maximizing the use of the technologists. Because we’re outpatient, a lot of our workload is fairly normal, and if it’s normal, they can let it fly out the door. The doctors get results back really quickly.”
New developments in technology are paired with new developments in testing methods. For example, Springfield Clinic labs recently changed to a testing method that increases speed and accuracy for a strep throat test. Before, technologists would have had to grow the bacteria on a throat swab for a couple of days before being able to tell if the culture carried strep or not. Now, technologists can test a swab at a molecular level using an amplified DNA probe and get strep throat test results back to a doctor more quickly. “Patients get results a lot faster, and some of the new technology is more sensitive and specific,” Tina says. Joe adds that where there used to be a little variance and more subjectivity in the strep throat culture testing, there’s not as much anymore thanks to this new testing method.
Making changes to testing methods is no small matter. Springfield Clinic technologists have to test the new method in-house before introducing it. They have to validate all claims about the new method and then notify physicians and their accrediting agencies that they are making the change. For example, the lab decided to move to DNA probe testing for strep throat—they could have stayed with bacteria culture growing. “The old methods are tried and true for a reason,” Joe says. “You definitely want to do due diligence and make sure that the direction you are heading is better than where you are coming from.”
Finally, Springfield Clinic labs know when they need to expand. Three years ago, the Main Campus lab site added a new histology lab, built under the guidance of a histology lab manager who had nearly 40 years of histology experience, Jim Vickroy. In the new lab, technologists are able to test almost all tissue samples collected at Springfield Clinic.
In fact, the “test menu” at Springfield Clinic labs is extensive. While their niche is not necessarily research and development, it is the high-volume tests that doctors order every day. “But there’s NO test our doctors can’t order,” Tina says. “Our doctors can order anything in the world they want. There’s nothing not available to them; they don’t even have to worry about that. The tests they want every day, though, that’s what we do.”
Samples are brought in all day, every day by the extensive courier network run by Springfield Clinic’s Facilities Department and an outside vendor, MedSpeed. Every single sample that is drawn is barcoded. The lab knows who drew it, when it arrived, when it was tested and when it got turned out. Also from that barcode, each courier knows how the sample has to be stored (room temperature, refrigerated or frozen) as well as exactly how many to pick up and drop off.
Using the computer network, technologists can track samples they know they’re supposed to have, even if they’re being shared to other sites or departments. There’s even a program that keeps track of what samples have been drawn so that if they don’t arrive at the Main Campus lab within the timeframe that a technologist expects it, the technologist can find the current location of the sample. Finally, the samples are tracked by day and kept until they can’t be tested anymore—just in case a doctor wants to add additional tests. The technologist simply searches with the sample number on the computer to find its exact storage location. “There are a lot of moving pieces that have to work exactly right to get that sample in the main lab to be tested,” Joe says.
Tina says that she is always looking at the courier schedules to see what improvements can be made. Since most of the testing “lag time” is due to transport between draw sites and testing sites, the pickup and drop-off schedules are crucial. Other than that, though, Tina and Joe are both very satisfied with the state of labs at Springfield Clinic. “The goal,” Joe says, “is to keep staying relevant, staying on the cutting edge and continuing to look at new ways of testing.” Tina agrees that while she doesn’t anticipate any big changes in the near future, it’s important to stay sensitive to new technology and new testing methods.
“The nice thing about lab is that we never stay static,” Tina says. “There’s always new test methods, there’s always new diagnostic tests. It kind of makes it a dynamic department.” Tina’s goal for now and for the future is to keep running quietly in the background and continue to support Springfield Clinic doctors and patients with high-quality, accurate and efficient lab work.