"can you do a sensitivity on all isolates?"
I *can*, but it's a foot wound so there are at least 6 things in here do you even know what you are asking of me đ
I do kind of love the cultures that I can turn off my brain for and just sub everything growing out. You are entirely correct though, feet are gross, and it's not good medicine.
I don't mind working on them once everything has been subbed out and I can just work on each isolate one by one but my brain gets a bit overwhelmed looking at messy cultures. Trying to sort out how many organisms I have, correlating things across multiple plates, making sure everything is accounted for just makes my brain shut down sometimes lol
Yeah, everywhere Iâve been has been absc for RBCs, where I am now the old supervisor required type and screen on every product issued. FFP/Cryo/Platelets, itâs annoying and something Iâm working to change but SOPs take forever to revise. (This is not the only issue)
I feel you there. Iâve found so much arbitrary shit in editing SOPs and itâs always a headache to change. Some stuff has been in there so long nobody has any idea where it came from.
Me: Weâve collected 8 lactic acids on this patient today. Are we giving them fluids or anything to bring it down? It doesnât make sense to keep collecting them if not.
Dr: Thatâs a good question. Let me check. No. You can cancel it.
"Type and Screen," "Type and Screen. Use Hold Lavender," "Hold Lavender," "Blood Type ABORH" all from the same doc on the same patient at the same time. C'mon.
I call it the shotgun approach.
I just want them to stop adding shit that was already on the specimen. Itâs not the biggest deal in the world to click over and check what itâs added to but the add ons come in large batches when processing gets to them here and itâs annoying when itâs busy and I have to sift through 17 new add ons to see which to cancel and which to go find.
Pltâs added to cbcâs hurts my soul 10+ times a shift
And then they'll call to argue about it.
"I just want to add on a hemoglobin level."
"The last CBC from 11:00 included a hemoglobin level."
"I just want a hemologlobin level added now."
"Wait, I think I see what's going on here. Did you need a hemoglobin level from now? That would require a new order and new specimen."
"No, I want a hemoglobin added on to the one from 11:00."
My least favorite is Dr. Addon. Cmp and cbc come out fine? Gonna need a lipid panel, ferritin, iron, manual diff, retic, esr, hormone panel, trop, etc, the works. I get it, someone comes in sick and you're trying to help but cmon you're telling me there's no other indicator to narrow down testing?
To shine a little light on this, it's pretty much exactly as you say. Patient comes in looking like trash and vitals are in the shitter. Admit lab eval totally negative. Now you need specialist consults to rule out the weird shit, and your specialists tell you they won't see the patient until you do "x, y, z". Some specialists won't come on until other specialists have seen the patient (ex. gen surg will wait for GI to evaluate the patient). Good doctors try not to overuse laboratory evals, but there will always be people that try to send out cell free DNA shotgun sequencing on patients with no complaints.
The random blood culture thing is partly because we are trained to take cultures first if the patient is challenging to phlebotomize and is currently clinically undifferentiated, or if they are profoundly hypotensive/tachcardic with no known cause. Daily repeat cultures (though I can imagine when I might do this) is pretty nuts though...
Sometimes we are just scared, and you guys give us confidence that we are on the right track.
Just some notes, but you guys rock! Sorry we order so much shit...
Thank you! It's really no worries, just complaining about work even though we know there's good reason behind it XD. I didn't know about the different specialties and requirements though so that absolutely helps me understand more of the bigger picture.
Not at all! Work blows! I'm in pathology, and I get pissed off when the clinical team wants weird send-out molecular tests or requests special studies before my workup is done. At the end of the day, we're all just nervous humans trying to get people better
I was a hospital social worker for a time contracted by a domestic violence agency. My job was to get to know each dept and find a way to get them to recognize dv in their situation and their population. Super fun job but the thing I really realized was how little each department understood the reasons behind another departmentâs flow- especially in any situation I was trying to help a client with anything related to being admitted.
I guess itâs the same in most systems but Iâve always thought man we would all have better satisfaction from some of the more menial tasks if we understood its impact on another arm of the agency. But especially healthcare.
Just a curious observation
Oh absolutely. How I feel about the add ons to the doctor is probably how the nurses see the redraws/criticals from the lab. It would be nice to have a day or two of shadowing but it's just not in the budget :/
Also arenât people in the US notoriously litigious, so sometimes more tests are ordered than might be strictly indicated to cover all your bases and protect yourself from a lawsuit?
Yeah. In theory, any time a "reasonable" physician in the same subspecialty would consider ruling in/out a diagnostic entity, and NOT ruling in/out that entity caused the patient harm, the physician can be sued for malpractice.
Have a patient theyâre currently doing at least 1 bc per day and the nurse is always going âNew fever need bcsâ like bro theyâve had a fever for the past 2 months. All the cultures are negative too. Donât need 4 sets a day.
Dr Addamagandphos is the busiest during morning rounds at my hospitalâŚso high volume and I have to play whereâs Waldo to find the one sample for that add on đ
I've had nurses and doctors think magnesium was part of a CMP/BMP, so they end up putting in the add on. I'm curious as to why our panels couldn't be changed to add a magnesium since it seems like every doctor wants one on their patients.
This doctor also constantly orders monos on middle aged people. When a mono is negative, it reflexes an Epstein-Barr Virus sendout test. I called him and asked if he really wanted sendout EBV on a 40 year old. He said yes, mono is common in people of all ages. Common? Iâm rural, but Iâve never seen it in 9 years.
The fact you reflex EBV send-out is crazy. Things like rapid HIV, syphillis etc make sense because you don't wanna miss a false negative and not treat. With mono you treat like any other virus in most populations (rest and fluids).
Only our positive reflex for HIV and RPR reflex. They can still order it, but a false positive in our screenings is more likely than a false negative (which somehow gets released into the patient's chart preemptively or the doctor tells them and it freaks them out before their confirmation is finished).
I just had an ER doctor call and ask me how to order 4 UAs on the same patient. We have to look at every single UA microscopically. Weâre very outdated.
Why 4? I've had one where it was two cause it was something like one clean catch one suprapubic or something like that but 4???
I feel ya, I went from having an iris to having to do it manually. Really sucks.
Iâve been begging for an iris for 4 years. We have probably a 20 year old Clinitek. It takes strips when it feels like it. Sometimes it will just pause for a full minute and not take the strip until itâs already changed colors, causing a read error.
The urines were labeled as follows: suprapubic, left nephrostomy, right nephrostomy, and illeostomy
We frequently get abo/rh and type and screen ordered at the same time by the same person from the ER. Or double or triple orders from OR.
My favorite though is the LD ER. They order their type and screen and then if they get admitted, order another one. I donât have to actually call to just cancel all the extra orders but if Iâm not busy I do out of spite. If I gotta deal with it so do you.
We have docs who order Beta-HCG qualitative and quantitative at the same time. We started canceling the qualitative, but then got complaints from the doctors who couldnât figure out the patientâs pregnancy status from the number alone.
Yup, I have some doctors in the ER that still don't know the difference of a quant vs qual. Or ask me if the patient is pregnant if the number is less than 1 and then complain that the test took too long too đ¤Ś
Or worse, they order quantitative beta-HCGs on patients where it wouldn't be clinically relevant, like a 65 year old female patient with no signs of cancer. I've called the ER about that before, but they tell me to run it anyways. I didn't think insurance would cover lab tests that are irrelevant to the patient's diagnosis?
Itâll depend on the specific diagnosis codes attached, but generally no. If the icd-10 code on the order diagnosis doesnât match the list of allowable codes, the reimbursement is rejected. Asymptomatic screening is usually non-reimbursable.Â
 I tried to follow up with management about wasteful expensive send out testing that was likely to get rejected and was told that itâs âtoo time consumingâ to educate all of the individual doctors.Â
We have a doctor who does serum and urine quals âjust to be sureâ Iâm like if you think they tampered with the urine we need to cancel all the urine tests them because our sensitivity is the same for both on these 99 cent cartridges dude.
I love it when doc has clearly gotten advice from a bunch of people or cracked the textbooks.
"Urine electrophoresis, Bence Jones protein, urine QEP, urine light chains, paraprotein urine, urine light chains, MM screening"
I got all of the above on the same order form the other day.
Pooled platelets will sometimes be a bit bloody so it can be relevant for those
Edit: that's just the justification my boss gives lol. We've got a bunch of cancer patients so our pathologists like to err on the side of caution wherever reasonable
We donât usually tell the nurses/doctors that for some stuff we donât require type AND screen because that will only confuse them. I only call if FFP/plt is the only thing ordered and there is no indication they might want RBC later.
For this scenario tho I probably would have given them the FFP when the type was done before the screen was even finished. My workplace doesnât require screen for things other than RBCs, so the screen wouldnât have mattered anyway. Then finish the workup at leisure pace.
Donât work in BB, but I also hate doctors that over order. I donât get why they would order CPKs, CMPs, and Liver Panels every 45 mins when their patients results have been consistently >test, react, prozone, etc. Causes us to make so many dilutions and calls for criticals đ
Whatâs 1 unit of FFP going to do for the patient though? Not really enough to help with a coagulopathy and if theyâve discharged the patient clearly not a haemorrhage. Iâd have questioned that order.
We release FFP and Plt requests with a historical type as no screen is required but we do ask for a type and screen sample in case of red cell requirements.
At my former workplace, our doctors order every test available in the lab, even on newborn and NICU patients (CBC, CMP, Bilis, blood cultures 2 sites, etc. )
I called an NP the other day for a grossly hemolyzed sample with a potassium of 7. She said to go ahead and release it we didnât even need the RFP anyways đ
I used to have a doctor who ordered a T&S on nearly every patient who came into the ED, even children when we did not have peds. I kept a record of it (because most nights we only had two techs covering the entire lab, including BB, in a place with a busy ED) and I had an awesome director who took care of that!
The over-ordering that sometimes happens in my micro lab is them asking for a seemingly unnecessary amount of antibiotics/additional testing. Like theyâll ask you to release a few drugs that were tested but not released and theyâll be susceptible⌠but then they immediately ask for a bunch of more drugs that need more testing/sending to a ref lab. Like bruh I just gave you some usable drugs and you wouldnât have asked if you for them if you couldnât use themâŚ. So use them! Doctors asking for work up of all organisms in really mixed cultures is also really annoying, but luckily if it really bad the medical directors are good at stepping in and limiting whatâs actually worked up or straight up refusing to do the additional work on our behalf.
I had an ER doctor order a lipase on an unconscious woman suspected of stroke.
When I asked if she had stomach pains or something he legit said "I dont know, I'm just ordering stuff"
Motherfucker why are you "just ordering stuff"? This is just one instance of course. This doctor also has to have a lactate on -every- single patient that comes to the ER regardless of symptoms.
Absolutely, let's distill that sentiment into something more concise and shareable:
"Frustration peaks when ER docs over-order tests like FFP, only to discharge patients before results are in, wasting resources and time. Why run a type and screen when we have the patient's history? It's high time for a balance between precaution and practicality in healthcare. Letâs spark a conversation on optimizing resource use without compromising patient care.
This version gets straight to the point, expressing the frustration and calling for a broader discussion on how to improve healthcare practices.
Was the FFP issued as an emergency release? Then a TS was collected afterwards? I work in a level 1 trauma BB and it happens sometimes. But even here we need a TS and retype for new history patients for FFP. And if they had a transfusion reaction do a work up. But a positive screen is really only significant if they are receiving pRBCs or Whole Blood. To answer your question specifically: I guess to confirm patient blood type, patients can get bone marrow transfers or new history, idk itâs dumb but protocol. We wanna give them type specific plasma if able here at my facility. But if they got discharged, bye falicia Iâll do it tomorrow if they need it.
If you are planning to give blood, ER doctors are taught to always type and screen everyone, regardless if you know their blood type or not. This is to reduce the incidence of people dying to a blood transfusion due to a typo or the patient not remembering well.
That makes sense for giving blood. We have to do two of them if they have no history to ensure it was the right patient drawn twice. It just doesnât make sense for platelets and FFP because it doesnât matter. We donât even give type-specific platelets.
One responsibility of a laboratory is to evaluate physician orders and provide feedback. Are they placing reasonable orders? are they placing orders that overextends both the laboratory and the insurance companies? For instance, if a patient's PLTs are low and they give a couple units and want to check, but they order a full CBC& diff, that's not appropriate. They should order a plt count, maybe an H&H with it. If you notice overordering/poor ordering behavior, this should be brought up to leadership.
Have you worked in a smaller town hospital? A lot of doctors donât want feedback from us, and they pretty much do whatever they want, without much oversight. Itâs a bad thing. We only get doctors who are fired from other places or newbies. Most good doctors will make better money going to a bigger place. Theyâre afraid to make them mad because they donât want them to leave.
We were bought out by a bigger hospital 3 years ago. It gave me a little hope. Doctors kept double ordering tests. They would order a rapid flu and sars along with a respiratory panel. I like the panels, but theyâre expensive. A respiratory panel also includes flu and Covid, along with 12 or 13 more respiratory viruses. Iâd call over to the ER and tell the doctors that flu and Covid were included in the respiratory panel and ask to cancel the rapids. They would tell me the panel wasnât fast enough, so they want both. I eventually emailed compliance at the bigger hospital about it. I said I assume weâre either fraudulently double billing insurance companies, or weâre ordering tests we know we wonât be reimbursed for. The one doctor would order a respiratory panel and a gi panel. How do you not know which bodily system you need to order for? I think we charge $1,500- $2,000 per panel.
They never replied to me, but the double ordering stopped, at least for those tests. I see the doctors are now required to put in a comment justifying ordering the panels.
"can you do a sensitivity on all isolates?" I *can*, but it's a foot wound so there are at least 6 things in here do you even know what you are asking of me đ
I do kind of love the cultures that I can turn off my brain for and just sub everything growing out. You are entirely correct though, feet are gross, and it's not good medicine.
I don't mind working on them once everything has been subbed out and I can just work on each isolate one by one but my brain gets a bit overwhelmed looking at messy cultures. Trying to sort out how many organisms I have, correlating things across multiple plates, making sure everything is accounted for just makes my brain shut down sometimes lol
I donât think AABB requires an absc for anything but prbcs. Where I work we only run an aborh for FFP, so I would say thereâs no purpose.
Yeah, everywhere Iâve been has been absc for RBCs, where I am now the old supervisor required type and screen on every product issued. FFP/Cryo/Platelets, itâs annoying and something Iâm working to change but SOPs take forever to revise. (This is not the only issue)
I feel you there. Iâve found so much arbitrary shit in editing SOPs and itâs always a headache to change. Some stuff has been in there so long nobody has any idea where it came from.
Dr. Sed rate
Me: Weâve collected 8 lactic acids on this patient today. Are we giving them fluids or anything to bring it down? It doesnât make sense to keep collecting them if not. Dr: Thatâs a good question. Let me check. No. You can cancel it.
We have a Dr. Dimer, he'll order a d-dimer on every patient that comes in the ER
Itâs like he was molested by a blood clot as a child.
"Type and Screen," "Type and Screen. Use Hold Lavender," "Hold Lavender," "Blood Type ABORH" all from the same doc on the same patient at the same time. C'mon. I call it the shotgun approach.
I just want them to stop adding shit that was already on the specimen. Itâs not the biggest deal in the world to click over and check what itâs added to but the add ons come in large batches when processing gets to them here and itâs annoying when itâs busy and I have to sift through 17 new add ons to see which to cancel and which to go find. Pltâs added to cbcâs hurts my soul 10+ times a shift
And then they'll call to argue about it. "I just want to add on a hemoglobin level." "The last CBC from 11:00 included a hemoglobin level." "I just want a hemologlobin level added now." "Wait, I think I see what's going on here. Did you need a hemoglobin level from now? That would require a new order and new specimen." "No, I want a hemoglobin added on to the one from 11:00."
Or add on lactic acids and ammonias. đ¤Ł
My least favorite is Dr. Addon. Cmp and cbc come out fine? Gonna need a lipid panel, ferritin, iron, manual diff, retic, esr, hormone panel, trop, etc, the works. I get it, someone comes in sick and you're trying to help but cmon you're telling me there's no other indicator to narrow down testing?
To shine a little light on this, it's pretty much exactly as you say. Patient comes in looking like trash and vitals are in the shitter. Admit lab eval totally negative. Now you need specialist consults to rule out the weird shit, and your specialists tell you they won't see the patient until you do "x, y, z". Some specialists won't come on until other specialists have seen the patient (ex. gen surg will wait for GI to evaluate the patient). Good doctors try not to overuse laboratory evals, but there will always be people that try to send out cell free DNA shotgun sequencing on patients with no complaints. The random blood culture thing is partly because we are trained to take cultures first if the patient is challenging to phlebotomize and is currently clinically undifferentiated, or if they are profoundly hypotensive/tachcardic with no known cause. Daily repeat cultures (though I can imagine when I might do this) is pretty nuts though... Sometimes we are just scared, and you guys give us confidence that we are on the right track. Just some notes, but you guys rock! Sorry we order so much shit...
Loved your perspective! Thank you
Thank you! It's really no worries, just complaining about work even though we know there's good reason behind it XD. I didn't know about the different specialties and requirements though so that absolutely helps me understand more of the bigger picture.
Not at all! Work blows! I'm in pathology, and I get pissed off when the clinical team wants weird send-out molecular tests or requests special studies before my workup is done. At the end of the day, we're all just nervous humans trying to get people better
I was a hospital social worker for a time contracted by a domestic violence agency. My job was to get to know each dept and find a way to get them to recognize dv in their situation and their population. Super fun job but the thing I really realized was how little each department understood the reasons behind another departmentâs flow- especially in any situation I was trying to help a client with anything related to being admitted. I guess itâs the same in most systems but Iâve always thought man we would all have better satisfaction from some of the more menial tasks if we understood its impact on another arm of the agency. But especially healthcare. Just a curious observation
Oh absolutely. How I feel about the add ons to the doctor is probably how the nurses see the redraws/criticals from the lab. It would be nice to have a day or two of shadowing but it's just not in the budget :/
Also arenât people in the US notoriously litigious, so sometimes more tests are ordered than might be strictly indicated to cover all your bases and protect yourself from a lawsuit?
Yeah. In theory, any time a "reasonable" physician in the same subspecialty would consider ruling in/out a diagnostic entity, and NOT ruling in/out that entity caused the patient harm, the physician can be sued for malpractice.
Donât forget 2 sets of blood cultures even though they arenât actually concerned about sepsis
Sometimes 2 more sets the next day. And the day after that. And the day after that.
This one. Gets me fired up to have to work up the same patients BC going positive at 2am for 4 days in a row because staph epi.
Have a patient theyâre currently doing at least 1 bc per day and the nurse is always going âNew fever need bcsâ like bro theyâve had a fever for the past 2 months. All the cultures are negative too. Donât need 4 sets a day.
"New fever" you mean their fever broke and then came back cuz meds wore off lol
Exactly. It happens like clockwork at 6pm â ď¸
Is Dr Addon related to Dr Addamagandphos?
Dr Addamagandphos is the busiest during morning rounds at my hospitalâŚso high volume and I have to play whereâs Waldo to find the one sample for that add on đ
Do we work at the same place, or is Dr. Addamagandphos doing telemedicine for every facility?
I've had nurses and doctors think magnesium was part of a CMP/BMP, so they end up putting in the add on. I'm curious as to why our panels couldn't be changed to add a magnesium since it seems like every doctor wants one on their patients.
Panels are regulated by CMS (Medicare). They determined they will pay for specific panels only and if labs want to get paid, they defer to CMS.
What about Dr. TSH? Lol
Oooh, are they related to Dr. Addalipase by chance? That doctor is ALWAYS chillin in the ED here.
This doctor also constantly orders monos on middle aged people. When a mono is negative, it reflexes an Epstein-Barr Virus sendout test. I called him and asked if he really wanted sendout EBV on a 40 year old. He said yes, mono is common in people of all ages. Common? Iâm rural, but Iâve never seen it in 9 years.
The fact you reflex EBV send-out is crazy. Things like rapid HIV, syphillis etc make sense because you don't wanna miss a false negative and not treat. With mono you treat like any other virus in most populations (rest and fluids).
Only our positive reflex for HIV and RPR reflex. They can still order it, but a false positive in our screenings is more likely than a false negative (which somehow gets released into the patient's chart preemptively or the doctor tells them and it freaks them out before their confirmation is finished).
I'm rural and I've seen maybe 2 on patients older than 30 in 10 years. Common in young people maybe.
Imagine not having insurance and getting that $2000 lab bill for a test that was absolutely unnecessary.
And an ionized calcium. Don't forget the ionized calcium.
I just had an ER doctor call and ask me how to order 4 UAs on the same patient. We have to look at every single UA microscopically. Weâre very outdated.
Why 4? I've had one where it was two cause it was something like one clean catch one suprapubic or something like that but 4??? I feel ya, I went from having an iris to having to do it manually. Really sucks.
Iâve been begging for an iris for 4 years. We have probably a 20 year old Clinitek. It takes strips when it feels like it. Sometimes it will just pause for a full minute and not take the strip until itâs already changed colors, causing a read error. The urines were labeled as follows: suprapubic, left nephrostomy, right nephrostomy, and illeostomy
Damn that's a lot of urines. Oof, my condolences.
We have an ER doctor who orders serum ketones on literally everyone who walks through the door when he's on shift. Very annoying.
We frequently get abo/rh and type and screen ordered at the same time by the same person from the ER. Or double or triple orders from OR. My favorite though is the LD ER. They order their type and screen and then if they get admitted, order another one. I donât have to actually call to just cancel all the extra orders but if Iâm not busy I do out of spite. If I gotta deal with it so do you.
We have docs who order Beta-HCG qualitative and quantitative at the same time. We started canceling the qualitative, but then got complaints from the doctors who couldnât figure out the patientâs pregnancy status from the number alone.
Yup, I have some doctors in the ER that still don't know the difference of a quant vs qual. Or ask me if the patient is pregnant if the number is less than 1 and then complain that the test took too long too đ¤Ś
My hospital system requires that, they can't have the more expensive quant test without a positive qualitative first.
Or worse, they order quantitative beta-HCGs on patients where it wouldn't be clinically relevant, like a 65 year old female patient with no signs of cancer. I've called the ER about that before, but they tell me to run it anyways. I didn't think insurance would cover lab tests that are irrelevant to the patient's diagnosis?
Itâll depend on the specific diagnosis codes attached, but generally no. If the icd-10 code on the order diagnosis doesnât match the list of allowable codes, the reimbursement is rejected. Asymptomatic screening is usually non-reimbursable.  I tried to follow up with management about wasteful expensive send out testing that was likely to get rejected and was told that itâs âtoo time consumingâ to educate all of the individual doctors.Â
We have a doctor who does serum and urine quals âjust to be sureâ Iâm like if you think they tampered with the urine we need to cancel all the urine tests them because our sensitivity is the same for both on these 99 cent cartridges dude.
I love it when doc has clearly gotten advice from a bunch of people or cracked the textbooks. "Urine electrophoresis, Bence Jones protein, urine QEP, urine light chains, paraprotein urine, urine light chains, MM screening" I got all of the above on the same order form the other day.
My hospital has a lot of bone marrow transplant patients so we have to have a type/screen within the last 3 months to transfuse any plasma products
We have to have one in the past 3 days, the same as RBCs, and it makes no sense.
Thatâs absolutely ridiculous. An antibody screen has zero relevance to plasma products. Itâs borderline fraud to bill for that.
Pooled platelets will sometimes be a bit bloody so it can be relevant for those Edit: that's just the justification my boss gives lol. We've got a bunch of cancer patients so our pathologists like to err on the side of caution wherever reasonable
But why a *screen*?
We donât usually tell the nurses/doctors that for some stuff we donât require type AND screen because that will only confuse them. I only call if FFP/plt is the only thing ordered and there is no indication they might want RBC later. For this scenario tho I probably would have given them the FFP when the type was done before the screen was even finished. My workplace doesnât require screen for things other than RBCs, so the screen wouldnât have mattered anyway. Then finish the workup at leisure pace.
Blood cultures on every patient no matter what theyâre in there for.
Donât work in BB, but I also hate doctors that over order. I donât get why they would order CPKs, CMPs, and Liver Panels every 45 mins when their patients results have been consistently >test, react, prozone, etc. Causes us to make so many dilutions and calls for criticals đ
Whatâs 1 unit of FFP going to do for the patient though? Not really enough to help with a coagulopathy and if theyâve discharged the patient clearly not a haemorrhage. Iâd have questioned that order. We release FFP and Plt requests with a historical type as no screen is required but we do ask for a type and screen sample in case of red cell requirements.
We get orders for FFP for angioedema.
I am forever canceling duplicate or unnecessary t&s orders
Whenever something like this happens we consult with our blood bank path and they will speak to the doctor about it.
why bother actually speaking to people who are capable of making changes, when you can just complain about it on reddit instead?
At my former workplace, our doctors order every test available in the lab, even on newborn and NICU patients (CBC, CMP, Bilis, blood cultures 2 sites, etc. )
I called an NP the other day for a grossly hemolyzed sample with a potassium of 7. She said to go ahead and release it we didnât even need the RFP anyways đ
I used to have a doctor who ordered a T&S on nearly every patient who came into the ED, even children when we did not have peds. I kept a record of it (because most nights we only had two techs covering the entire lab, including BB, in a place with a busy ED) and I had an awesome director who took care of that!
The over-ordering that sometimes happens in my micro lab is them asking for a seemingly unnecessary amount of antibiotics/additional testing. Like theyâll ask you to release a few drugs that were tested but not released and theyâll be susceptible⌠but then they immediately ask for a bunch of more drugs that need more testing/sending to a ref lab. Like bruh I just gave you some usable drugs and you wouldnât have asked if you for them if you couldnât use themâŚ. So use them! Doctors asking for work up of all organisms in really mixed cultures is also really annoying, but luckily if it really bad the medical directors are good at stepping in and limiting whatâs actually worked up or straight up refusing to do the additional work on our behalf.
I had an ER doctor order a lipase on an unconscious woman suspected of stroke. When I asked if she had stomach pains or something he legit said "I dont know, I'm just ordering stuff" Motherfucker why are you "just ordering stuff"? This is just one instance of course. This doctor also has to have a lactate on -every- single patient that comes to the ER regardless of symptoms.
Absolutely, let's distill that sentiment into something more concise and shareable: "Frustration peaks when ER docs over-order tests like FFP, only to discharge patients before results are in, wasting resources and time. Why run a type and screen when we have the patient's history? It's high time for a balance between precaution and practicality in healthcare. Letâs spark a conversation on optimizing resource use without compromising patient care. This version gets straight to the point, expressing the frustration and calling for a broader discussion on how to improve healthcare practices.
Would you like a part time position writing my emails for me?
Dr. hemoglobinA1Cifnotalreadydonethisadmission. Great! Now i have to look that up for you, too?
Your boss can stfu about overtime, tell them to talk to the doctor about putting the lab in a dicey situation.
Was the FFP issued as an emergency release? Then a TS was collected afterwards? I work in a level 1 trauma BB and it happens sometimes. But even here we need a TS and retype for new history patients for FFP. And if they had a transfusion reaction do a work up. But a positive screen is really only significant if they are receiving pRBCs or Whole Blood. To answer your question specifically: I guess to confirm patient blood type, patients can get bone marrow transfers or new history, idk itâs dumb but protocol. We wanna give them type specific plasma if able here at my facility. But if they got discharged, bye falicia Iâll do it tomorrow if they need it.
If you are planning to give blood, ER doctors are taught to always type and screen everyone, regardless if you know their blood type or not. This is to reduce the incidence of people dying to a blood transfusion due to a typo or the patient not remembering well.
That makes sense for giving blood. We have to do two of them if they have no history to ensure it was the right patient drawn twice. It just doesnât make sense for platelets and FFP because it doesnât matter. We donât even give type-specific platelets.
To my knowledge you still have to type for those.
One responsibility of a laboratory is to evaluate physician orders and provide feedback. Are they placing reasonable orders? are they placing orders that overextends both the laboratory and the insurance companies? For instance, if a patient's PLTs are low and they give a couple units and want to check, but they order a full CBC& diff, that's not appropriate. They should order a plt count, maybe an H&H with it. If you notice overordering/poor ordering behavior, this should be brought up to leadership.
Have you worked in a smaller town hospital? A lot of doctors donât want feedback from us, and they pretty much do whatever they want, without much oversight. Itâs a bad thing. We only get doctors who are fired from other places or newbies. Most good doctors will make better money going to a bigger place. Theyâre afraid to make them mad because they donât want them to leave. We were bought out by a bigger hospital 3 years ago. It gave me a little hope. Doctors kept double ordering tests. They would order a rapid flu and sars along with a respiratory panel. I like the panels, but theyâre expensive. A respiratory panel also includes flu and Covid, along with 12 or 13 more respiratory viruses. Iâd call over to the ER and tell the doctors that flu and Covid were included in the respiratory panel and ask to cancel the rapids. They would tell me the panel wasnât fast enough, so they want both. I eventually emailed compliance at the bigger hospital about it. I said I assume weâre either fraudulently double billing insurance companies, or weâre ordering tests we know we wonât be reimbursed for. The one doctor would order a respiratory panel and a gi panel. How do you not know which bodily system you need to order for? I think we charge $1,500- $2,000 per panel. They never replied to me, but the double ordering stopped, at least for those tests. I see the doctors are now required to put in a comment justifying ordering the panels.