If someone asked you to make a list of people who work in a hospital, chances are doctors and nurses would be the first professions that come to mind. Those professions have very patient-facing roles in our healthcare system. However, there are many, many other professionals in a hospital who play integral roles in providing patient care. In this edition of Seasons Magazines, we put the spotlight on the Department of Laboratory Medicine at Charlotte Hungerford Hospital. We interviewed five members of the staff and the medical director of the department for this article.
What is laboratory medicine?
Laboratory medicine is a branch of medicine that involves the testing and analysis of bodily fluids (e.g. urine, blood, spinal) or tissue samples (e.g. biopsies, smears). Physicians use the results of these tests to diagnose disease and monitor or guide therapy. Laboratory medicine encompasses many types of analysis such as blood chemistry, hematology, coagulation, blood banking, microbiology, immunology, toxicology, urinalysis, serology, and cytology.
Most hospitals have their own laboratory departments. Laboratories may also be found within clinics, public health departments, universities, or as independent commercial entities. Hospital laboratories are accredited by The Joint Commission as part of the hospital accreditation process. A lab may also opt to apply for accreditation from the College of American Pathologists (CAP). Dr. Mezzetti explains, “It is a more stringent standard. To be accredited by CAP is not a requirement but a privilege.”
People work in different roles within a laboratory. Here is a brief description of the common roles:
Phlebotomist – a person who draws your blood for laboratory tests. This must be done with great skill to assure it is done safely and accurately. This role requires completion of a training program (usually 1-2 semesters) and certification at the state or national level.
Medical Technologist (sometimes referred to as Clinical Laboratory Scientist) – a person who performs and interprets the clinical laboratory tests. Technologists may specialize in certain types of laboratory analysis. This role requires a two- or four-year degree and certification from the American Society of Clinical Pathologists (ASCP). Individuals in this role may rise to supervisory and managerial roles within the department.
Laboratory Assistant – a person who provides support to medical technologists. Duties may include registering patients, receiving and processing specimens, and performing some basic lab tests. Generally, a high school diploma with the addition of some targeted coursework and experiential training is required.
Medical Director – a medical doctor, commonly a pathologist, responsible for oversight of the laboratory.
The Lab at Charlotte Hungerford Hospital
The group describes the Department of Laboratory Medicine at Charlotte Hungerford Hospital as a small generalist lab. It is CAP-accredited and provides clinical laboratory services for blood bank, hematology, coagulation, chemistry, urinalysis, serology, microbiology, and pathology services for anatomical pathology and cytology. They also provide point-of-care testing. Stephanie explains, “This is lower complexity testing that may be performed at the bedside by select healthcare personnel. For example, if a patient of childbearing age comes in with a trauma, a pregnancy test will be performed at the bedside, so the patient can go to imaging quicker.” Even though point-of-care tests are performed by non-laboratory personnel, the lab is responsible for the training, inventory, and quality control of all of them.
“The laboratory is a staple of the hospital. A lot of people don’t know much about it but they do a lot of important work,” Dr. Mezzetti exclaims. Several of the staff admit that they prefer to be “behind the scenes” but feel that their contribution to patient care isn’t always recognized by other health care personnel or certainly by the public. “Contrary to what other people may think, we do save lives, we’re not just pushing out numbers,” Julie interjects. She references the medical technologist’s role in mass transfusion protocols for trauma patients. Without a medical technologist carrying out blood testing accurately and efficiently for the blood bank, such a protocol would not be possible. Maria, who works in the anatomic pathology department provides another example, “We see the specimen as soon as they’re taken from the patient, a gallbladder, or a tumor. So it’s important that we get that out quickly to get that processed so the pathologist can get a diagnosis. For some patients, a matter of hours or days may make a difference in their treatment or outcome,” she explains.
Even though the lab utilizes lots of instrumentation and the technology and software related to this machinery has evolved (and continues to) so that it requires less personnel to operate, humans still play a very important role in the lab. All of the instrumentation must be properly maintained. Before a specimen is placed in an instrument, the machine must be calibrated and lots of quality checks must be performed to assure the instrument is accurate. When an instrument indicates an abnormal result, it must be verified by a technologist. For any “critical values,” test results significantly outside the normal range that may represent a life-threatening situation, lab personnel must verbally communicate them promptly to a nurse or physician so the result can be acted upon without delay.
The lab operates 24 hours a day, 7 days a week, 365 days a year, including all holidays. These are not jobs that can be performed remotely. The lab is staffed by 32 individuals (some part-time) plus a laboratory manager, a medical director, and a laboratory director (a shared position between Charlotte Hungerford and Hartford Hospitals). For comparison, the group explains, labs in large academic medical centers might have thirty-two people in just one analytic section of their lab. Last fiscal year, the lab performed 329,729 tests, close to 1000 tests a day on average.
Dr. Mezzetti explains the lab has a dual leadership structure which is unique. As the medical director, he is responsible for compliance, accreditation, anatomic pathology, and communication with the medical community. The lab manager, Maryann Morse, a medical technologist, serves primarily as an administrative director and is responsible for daily operations including personnel and finance. “Our roles complement each other. She is a working partner that I value,” he says.
But “the techs are really the subject matter experts in their specializations and they’re really the backbone of the operation,” he proclaims. Many of the staff members have worked in this lab for twenty or more years. Dr. Mezzetti is a relative newcomer, having joined the group as the Medical Director in February 2020. Several in the group attribute the duration of their tenure to liking the small lab setting and specifically Charlotte Hungerford Hospital. They cite a few reasons for this. The small setting requires them to keep their skills up in several different analytic areas which keeps their jobs interesting. And, there is a very family-like atmosphere at the hospital. Because it is a small group, they have to help each other out in terms of covering breaks, sick calls, and vacations.
Dr. Mezzetti, who has worked at labs of varied sizes across the country in his 20 years of practice, agrees. He was attracted to the job and Charlotte Hungerford Hospital because of the sense of community and family it projects. He notes the staff is very cohesive, “They work extremely hard for one another.” He also prefers the smaller community hospital setting because “You really sense the impact that you’re making in the improvement of healthcare for your community. You see a direct consequence of your actions and it’s very fulfilling.” He is quick to point out that the hospital really offers patients the best of both worlds. He explains that because of their affiliation with Hartford Healthcare, the lab is undergoing a standardization process resulting in newer, state-of-the-art instrumentation, “So it is really a very nice blend of that community feel but it has the advanced capability of a medical center.”
Accomplishments and Challenges
Dr. Mezzetti and the staff highlighted several advances the lab has made in the last few years:
Supporting Faster Diagnoses: They were the first of the Hartford Healthcare affiliate labs to incorporate a new method for testing cardiac enzymes, a test that may indicate a person is having a heart attack. This new method helps to shorten the time for definitive diagnosis from 6 or 8 hours to approximately 2 hours. Similarly, the lab has been involved in the hospital’s stroke certification process. For that, the lab needs to demonstrate they can return results within a certain amount of time in order to aid the diagnosis of stroke.
Expanding Capability to Meet Patient Needs: The affiliation with Hartford Healthcare has expanded the patient populations that are cared for at Charlotte Hungerford Hospital. This includes treating patients with various types of cancer, some of them who are very sick. The lab has increased its capability in order to support the growth of oncology services at the hospital. This enables this patient group to receive excellent care closer to home.
Pioneering Innovation: They were among the first affiliate labs to utilize cutting-edge policy and procedure management software. This electronic document control system streamlined their efforts to create and maintain department policies and procedures which frees up resources to focus on patient care.
Aside from the COVID-19 pandemic, one of the major challenges for the department has been an ongoing labor shortage. They currently have seven unfilled positions. The group notes that this is a problem across the country and is related to multiple factors. They explain that many academic institutions have done away with medical technologist programs. They also fault the profession as a whole for not advertising and promoting itself as a desirable career path. There are simply fewer individuals entering the field than are retiring. Bernadette provides a sales pitch, “Medical technology is a really good field for someone who would like to go into healthcare, but maybe doesn’t want to have direct patient care responsibilities. It’s a decent paying job and there’s lots of flexibility in scheduling.”
In addition to recruiting new staff in the coming year, the department will be busy with renovations of the physical space as well as augmenting and updating instrumentation, all in an effort to grow their services and increase efficiency. Of the lab personnel, Dr. Mezzetti boasts, “They’re highly trained, extremely intelligent, very good at what they do and I’m very proud of them.”
Margaret M. Burke, Pharm.D., BCPPS, is a freelance medical writer with more than 25 years of clinical pharmacy experience, including board certification as a pediatric pharmacotherapy specialist. She lives in Manchester.
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