St. Joseph Laboratory Services

RESULTS	SJRL provides the fastest turnaround time (TAT) possible for all tests. Most routine laboratory tests are resulted within one to two hours of receipt. Once resulted/verified, the report is immediately available in the Patient Care Inquiry (PCI) module of MEDITECH®. Hard copies of results are available on a scheduled basis. Microbiology cultures are read and reported out once daily with susceptibility tests resulted upon completion of incubation. Pathology diagnoses on tissue biopsies are generally available the next working day following submission. SJRL processes specimens from several areas and must prioritize this workload to accomplish quality patient care. The laboratory handles specimens from various locations in the order listed below: Trauma Patients Cardiac Operating Room (OR1) Emergency Services Patients Intensive Care and Surgical Patients STAT Requests from areas other than Emergency Services Routine Patient Tests Outpatients SJRL is a computerized laboratory with many instruments directly interfaced to the laboratory computer system (MEDITECH®) to speed result transmission. All results are available upon verification in the MEDITEC® computer system. Physicians are encouraged to use the PCI (Patient Care Inquiry) module to look up test results. Numerical results are presented in a graph format in PCI to aid the physician in trending individual test results (i.e.: Accucheks, potassium, WBC, etc.). Abnormal Results: Indicated by (*) on the laboratory report. A policy change was made concerning the calling of after-hours (after 5 pm) Outpatient Laboratory "abnormal results." Unless otherwise specified an Outpatient Laboratory Abnormal Value will be called to the ordering physician (office or clinic) the next business day. Any physician wanting Laboratory results paged after-hours should indicate this on the order. Panic/Critical Results: The Laboratory also designates certain test values as panic or critical values. Indicated by (*) on the laboratory report. Results will be called immediately. Delta Results: Indicated by (#) on the laboratory report. This is an internal quality assurance monitor. Results are flagged with a Delta flag if the previous sample was grossly different (i.e.: Hemoglobin changes by more than 30 % on samples run on the same day.) Laboratory personnel must investigate and document a reason for abnormal analyte variation such as patient receiving blood, wrong patient drawn or follow through with appropriate actions such as retesting. Hard copy patient results are printed two times daily for hospital inpatients and placed on the chart by unit secretaries. Hard copies are faxed, mailed or delivered to physician offices for outpatient laboratory tests. SJRL does not release results to patients over the telephone. A patient may obtain a copy of their results by presenting to the SJRL office with proper identification.
ORDERS FOR LABORATORY TESTS	Laboratory tests must be ordered by a licensed physician or practitioner. All tests ordered must have supporting "medical necessity" based on the patient’s diagnosis, condition or symptom. Medical necessity can be documented as a narrative description or as an ICD-9 code. Orders for laboratory tests may be faxed to: o 776-5980 Osler Blvd Collection Station o 776-5321 Professional Building Laboratory Collection Station o 776-9369 East 29^th Street Laboratory Collection Station o 776-2406 Hospital Laboratory Verbal orders for laboratory tests on Outpatients must be verified with a written order from the physician (CLIA ‘88 regulation). A copy of the written order from the physician for the laboratory test(s) must be on file in the laboratory.
REFERENCE LABORATORY	SJRL currently uses Specialty Laboratories, Inc. from Los Angeles, California for tests not performed in-house. Specialty Laboratories is used mainly for esoteric or low volume testing. A courier picks up specimens two times per day for air shipment to Specialty. Results are received electronically several times daily. Results from Specialty Laboratories are sent to the patient’s medical record chart and the patient’s physician. NOTE: SJRL periodically reviews and re-evaluates reference laboratory services. Physicians and Clients will be notified of any changes as soon as possible.
THERAPEUTIC DRUG MONITORING	The laboratory performs a wide range of therapeutic drug monitoring (TDM). Peak and Trough timing is very important for several drugs like the aminoglycosides. To provide the best care to the patient the laboratory prefers to monitor a single dose of drug. Peak levels for aminoglycosides should be obtained 30 to 60 minutes after the dose is administered depending upon the route of administration. Peak levels for Vancomycin should be obtained 2 hours after the dose is administered. Trough levels should be obtained immediately before the next dose of drug is administered.