Lab Errors

I have worked in labs for over thirty years. Most of that time was spent in clinical labs which are labs that service the needs of patients and the clinicians, your doctor. Over that time inspections have increased. Rules have been made to insure tests are done correctly. Those rules are usually the result of mistakes that have caused death or other grievous harm to a patient.

In 1988 I witnessed the effects of CLIA ’88 on the labs. CLIA ’88 is an Act of congress that regulates lab testing through CMS.

CLIA logo

Because of it, I saw labs require their technologists prove they had the education necessary to do their job, or they were grandfathered in because they had the experience. In most states they needed to get certification to work regardless of experience. They were watched to be certain they did things properly and the tools they used were the right tools.

Before CLIA ’88, to the best of my recollection, only The Joint Commission would inspect the hospital.

The Joint Commision
Inspecting commission for Hospitals and Labs

The Joint Commission stayed in the patient areas, the ICU, the surgical suites, places like that. After CLIA ’88 the labs were inspected but the other labs were given the majority of the attention.

Histology has always been the half ignored stepchild of the laboratory system. The techs who work in the area are typically paid less. The area is usually given the least functional room with the least space and the lest help. On the other hand, it is an interesting lab in which to work. Histology is the lab that will let a patient know if they are free of cancer and if not, how hard it will be to fight that cancer. Less space isn’t a problem because our processes are mostly manual so our equipment doesn’t take up large spaces. However, we can’t do it with less help, and less than competent help can cause more problems than a lack of help.

As one of the smaller labs with less support, less pay, and less respect, Histology doesn’t attract the better help. There are usually a few people in each lab who are competent in performing all tests and who understand and appreciate how their work impacts the lives of others. In contrast to them, there are also people who are neither competent in performing all tests nor willing to improve.

This is the type of technologist CLIA ’88 sought to improve with proficiency testing. It should be the means to improve but the supervisors always give proficiency tests to the most proficient tech.

CAP, The College of American Pathologists, is the organization that tests our lab and sets the standards.

CAP logo
CAP inspects the lab

They send the proficiency tests and supervision gives the test to a tech to complete. Would any supervisor give the test to the least proficient? No, they give it to their best tech so they avoid problems with their lab certification. The test is returned and looks great. In the meantime, there are techs in the lab who cannot do all of the tests.

This matters to patients because they need their biopsies and their surgical specimens handled correctly all of the time. The pathologists need to trust their lab or they might start to second guess the validity of a test.

I don’t know the best way to force education on techs but I think it needs to be done. I know given my lower wages compared to Med Techs, I wouldn’t pay for it. I’d quit instead. I wouldn’t spend my weekends in classes or at conventions either. My work is stressful. I need the down time.

I would be willing to test and teach my fellow employees. I would, and do, answer complex questions. I am willing to help them complete tasks that test their competency as long as they learn in doing so. Techs who want to learn become more competent. However, for them to learn, labs must have experienced people who can teach and those people must have the time.

Other than techs teaching their co-workers, there are many means to improve the processes and the people. ASCP, the college of clinical pathologists offers online training. Most of it is for pathologists and Med Techs. More can be made available for histologists.

There are ways to measure improvement too, ways that do not rely on counting how many errors occurred with patient tissue. Instead, individuals or systems can be tested with mock trials.

That kind of testing and teaching for improvements take time and effort which are in short supply. Hospitals are funded in large part by Medicare and Medicaid payments. logo-medicare-certifiedThose payments for services are slashed by the government each year. That results in hospitals with less money. Therefore, they pay less, hire fewer employees, and do whatever they can to save money.

Hospitals have experienced a downward spiral of funding as Medicare and Medicaid funding is reduced. Employees are expected Medicaid_icon_300x300-1to do more tasks and eventually they fail or realize the futility of keeping up with the pace of their work. That is when they start to cut corners. Cut enough corners, and procedures are gone, they fail. But that failure means it will be too late for someone. It means a life is lost.

Improvement is typically made after tragedy. That is when Acts like CLIA ’88 are passed. That Act came into being because too many Pap Smears were incorrectly diagnosed. CLIA ’88 put standards in place because of misconduct in labs. Isn’t this always the way? A generation has to be hurt for problems to be addressed.

I believe we don’t have to wait for the next person to be hurt. Patients whose biopsies are poorly processed can take action. Patients can ask questions when things go wrong and shed light on the process that caused the pain. Patients need to complain. That will make hospitals realize their lab processes are in error, mismanaged, or poorly staffed. After all, if labs were willing to change without someone making them change, CLIA ’88 wouldn’t need to exist.

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If this subject interests you, here is an article By Ellen Gabler of the Journal Sentinel about another type of test, the ‘waived test’ Hidden Errors . These are tests than anyone can do but doing them wrong can cause grave consequences.

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