“All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” – Institute of Medicine (US) Committee on the Health Professions Education Summit; Health Professions Education: A Bridge to Quality. National Academies Press (US); 2003.
As a Doctor of Clinical Laboratory Science (DCLS), I actively participate in interdisciplinary teams providing patient-centered care during patient care rounding. During rounding, the team discusses each patient, often involving the patient and/or their family members, and formulates a patient-specific plan for diagnosis and treatment following evidence-based practices. My role, besides performing bedside point-of-contact laboratory consultation, is to identify educational needs of the team to improve the overall quality and safety of patient care. This often also decreases tensions and animosity between the laboratory and other healthcare departments.
Recently I was rounding with a Pediatric care team and came across such an opportunity. Before the patient discussion began, the chief resident mentioned she had a couple of questions for me. The first question: “We get calls from the lab all the time about clotted specimens. Is there anything we can add to the tubes so that it doesn’t clot?”
This team comprised of several resident physicians, medical students, an attending physician, clinical pharmacist, and nurses, had prepared to ask me this question. I could hear the frustration in their voice and this was a perfect opportunity for education and patient care quality improvement.
We assume that since these are fellow healthcare professionals that they understand blood collection. They do not. I explained how the purple top tubes already contain EDTA and the mechanics of how it prevents coagulation with proper collection technique. Towards the end of this explanation I was interrupted with the following statement from another resident physician: “I thought the different colored tubes just told y’all which department they go to.” This allowed for additional education on the different tube types.
The second question was then posed by the chief resident: “The other problem we have is that the nurse calls the lab to find out the minimum amount of blood we need to get for a test, we collect that amount and send it, but then the lab calls and says it’s not enough. Can we please get the lab to give the right information to the nurses?”
When I asked for an example of a recent test in which this occurred, it was a send out test with a requirement for serum. When the nurse called to ask how much blood was needed, the laboratory professional looked up the test and replied 1 milliliter (mL) of serum. When I questioned a nurse: if the laboratory professional told you 1 milliliter (mL) of serum was needed for a test, how much blood would you collect, she replied: 1 milliliter (mL). Here was another opportunity for education and quality improvement.
Resulting from this encounter is the scheduling of a nurse in-service to educate our fellow healthcare professionals in tube additives, and the difference between serum, plasma, and whole blood. We are also training the laboratory staff to ensure that, especially on our tiny pediatric patients where we must minimize the volume of blood collected, to confirm with the nurse calling the volume of whole blood they must collect to provide sufficient serum or plasma if required by the test.
By doing these educational sessions, not only do we improve communication between nurses, physicians, and laboratory professionals, but we also improve patient care and patient safety by reducing the number of unnecessary collection of multiple specimens. These were questions that did not require the expertise of a DCLS; only the desire of a laboratory professional to improve relationships with other healthcare professionals and improve the quality and safety of patient care.