Preface: For those that don't know I work as an MLT in a medical testing lab. If your doctor takes any kind of sample be it blood, sweat, or skin scrapings we are the guys who test it.

Lab tests are a significant factor in diagnosis, treatment, and long term care. This isn't about CDA VS USA but believe me when I say that every Canadians gets a far better deal and far cheaper testing done under our system of billing but thats not the topic of this thread.

This thread has to do with the constant stream of bureacratic nonesense that we often have to deal with. Now in our buisness, bueacracy such as proper labeliing and proper protocls are essential but sometimes they force us to adopt policies that are simply absurd. Its akin to when the compnay had us Y2K testing equipment that had no electronics.

Our lab is inspected on a bi-yearly or yearly schedule depending on the department. OLA. or Ontario Lab Accreditation handles our lab and supposedly they are all experienced in how my job works.

Our Ottawa site got docked for what is my main thesis. "improper use of short sample cups".

Probably means nothing to you guys. If you have ever had blood drawn then you know it goes into a tube. These tubes are usually 13X75 but can often be smaller depending on the patient and technician as well as sample requirements.

We process some 15-25 thousand patient samples per day and that voluem goes through large analyzers capable of handling the output. (all these tests used to be donw one at a time through manual methods that we still do on some tests (neo-natal bilis for example).

The analyzers can be very picky about what size tubes it can accomdate and the level of the sample in the tube. Very very often we get sample that end up with very little actual sample to work with (eg. because it was a bad draw and little blood was obtained). For those samples we simply pour it off into special cups that fit inside the tube and bring the level up to a point the analyzers can read, or we used to do that.

The good folks at OLA dinged Ottawa (subsequently forcing us to comply) because the sample cups weren't document controlled. Thats a fancy way of saying we didn't write the patients name and specimen number on a tiny sample cup about a quarter the size of a thimble. Needless to say its not only extremely difficult to do let alone be readable but it slows us down alot.

Our other option is simply toss the cup sample and all once it is analyzed thus destroying the sample in the cup.

Do you see the stupidity? We are using the cups because we have very little sample to work with yet these good folk who realize we are all trained and licensed MLTs doing a skilled job seem to think we are incapable of picking a cup up and pouring it back into its original container, a method in use since these containers were invented.

The large volume means that often a sample tube must go to several different stations to get all remaining tests done then stored until later when we check to see which tests were missed or do repeats or even to check a weird result.

Here's the rub: Under their protocols we are essentially throwing away 5-10% of our samples befiore completely the ordered work.

Shortsighted in the least. So a patient goes to a doctor, the doctor obtains a sample, we send a driver to pick it up and it comes back to our lab and goes through a whole process only to be thrown away with only partial work done thereby forcing the patient to do it all over again or the doctor to render a diagnosis with incomplete info.

Mindboggling. I understand that bureaucracy exists to feed itself but our health shouldn't have to suffer. This is exactly the kind of thing that delays treatment and raises expenses.

/rant.

   

No offence and no intention to start a Can vs USA thing.

This is about government controlling health care (or anything else for that matter).

You inevitably end up with nonsense regulations being created by people who have no idea about what it is they're regulating.

What you do in your job with your process saves money. And it makes sense.

You should be commended for your good work.

But no, that isn't allowed under some fool regulation that was written most likely by a lawyer and not a doctor or someone who'd have a clue what the regulation would actually do.

For instance, down here we had an idiot on city council ram through a firearms regulation that applied to our own police department.

The law required the registration of ballistics from smooth-bore shotguns.

Something that is utter nonsense.

Deborah Ortiz, who sponsored the idiocy, had never discussed this with a firearms expert and instead let a lawyer from a gun control advocacy group write it up.

Health care should be run by health care professionals. Unfortunately, when you let a government run healthcare it'll inevitably be run by civil service bureaucrats who are little lemmings with their silly regulations and nonsense.

   

Unfortunately they exist in both countries. In order to provide legally recognized test results for our US customer base we are also inspected and lincesed by CAP (College of American Pathologists).

They pretty much certify all US labs. Luckily they are a little better,



Their website says they use experienced people but I wonder.

In all honesty they aren't any different then the people who license us (and ours are as bad as yours).

They need to keep justifying their work so they keep inventing rules. Buy a gameboy out of petty cash and leave us alone.



Is it even possible to get any balistics from any type of shotgun?



Agreed. They tell us they are being run by healthcare professionals but I think that once you become a "bureacrat" its like loosing your viginity....... There is no going back to the way you where.

   

A smooth bore shotgun has no ballistics. Thus the law commanded an action that was impossible.

And forgive me this, but any healthcare professional who decides to become a 'crat probably wasn't much of a healthcare professional.

   

Those who can do.

Those who can't teach.

Those who can't do anything administrate.

   

The DCN (document control number) is it listed on the tubes?

   

No as such. By Document control I mean a catch all phrase they used to say we should have patient identifyers on all seperate aspects of that patient sample. Every tube and sample container must contain the information. They have labelled the sample cup as a "seperate" container even though its simply a small cup that we pour sample from the tube into and then immediately set back inside the tube.

Its really a simple procedure but what they want will either slow us down alot or else waste alot of sample and subsequently fail to perform all needed testing.

   

Understood. Are they using this for tracking purposes for integrity of sample tracking all possible items that have interacted with said sample? Seems redundant if the tube is already listed, perhaps a sub category for a cup could be used but since it all ends up in an incinerator I cant see the reason here. There must be more going on.

   

My supervisor explained it like this:

They are concerned that any "seperate container" that is not properly identified might be attributerd to the wrong patient and that possible cross contamination may occur.

In simpler temrs they they are worried that we may pour off sample fluid into a cup then place that cup onto a different tube or that when we go to repour the contents back into the original tube we may inadvertently pour it into the wrong tube.

Sure its possible but we already have that problem with the specimen collection and processing people, and the chance for error is very very slim.

For a decent anology I refer you to the various shooter girls that sell shooters in test tubes at night clubs. They come around with a tray that has a rack holding 10 or 15 shooter tubes. The proportions are similiar.

Imagine those tubes had only a small amount of fluid and you had to pour it off itno a special cup that fit nicely in the top.

Now imagine a whole row of those tubes all with cups. How hard would it be for you (sober) to lift the cup out of a specific tube and pour it back into the tube?

Thats essentially what we are talking about.

Risk Vs reward. The rsik associated with that procedure is validified by the timely volume of results we can deliver.

   

More like liability issue to me. I agree this slows the system down but the liability assumed if that one in a million mistake is made would be revealed when the ensuing inquiry is completed and guess who is holding the bag then? Not some lab tech but the whole parent company could be out of business. Simply put the bean counters will not put their butt on the line for a 98% chance of success. It must be 100% for them or no deal.

   

If that were the actual case then we would have a system whereby the patient themselves hands the specimen directly to the technologist who then signs for it, runs it, then posts the results.

Believe me when I say there is far far greater chance for error long before it gets to us. I know because I have personally caught sample mislabelled with the wrong barcode. Any truly anomlous test result and the doctor will confirm it or we will test a different sample tube if we get multiple samples.

Imagine printing your name and telephone number on a couple hundread pen caps. As it is most days our volume is so high that we barely finish and our lab runs 24/7.

Its akin to saying that all drivers at every stop should get out of their car and do a walk around "just to make sure no kid has suddenly fallen in front of the car. Same idea about saving one in a million right.

The risk of missing that one in a million is far less then the risk to all the patients who won't get test results or must wait a few days longer.

   

Any response will come later. I've got to jet off to work.

later.

   

Preachin to the choir and I wish there was something better. I run into the privacy and freedom of information act more than liability issues but it creates the same headache of paperwork. When it comes to that the only course of action to really change the system is to redress the federal minister of health as policy ultimately comes from the top down or contact the local MP. Trying to appeal to bureaucracy common sence is like talking to a brick wall.

   

It's the same in other industries Derby. In the automotive industry, parts suppliers can lose their right to bid on new parts when audited by a third party and fail the audit.

The auto assembling companies(Ford, GM, Chrysler, et al) also rank their suppliers on several levels which affects a suppliers chances of landing new business.

Defects at the customer(assembler) is a huge problem. Even one bad part out of thousands can end up costing a supplier millions of dollars depending on the part in question. The assembler can demand that the supplier replace the entire suspect lot and even send a third party sorting company into a suppliers factory to ensure good parts.

I`ve seen people fly to Mexico on a moments notice because of bad parts, I`ve seen helicopters land in the parking lot to pick up replacement parts, and I had an employer pay for the cost of replacing several thousand parts that were already installed on vehicles at $250 per vehicle.

Auto parts are lot controlled and quality controlled at every step of the process, no matter how mundane that part is. Bad parts found during the process at the supplier or at the customer generate paperwork and further analysis to prevent further occurances. The customer can demand all sorts of steps be taken to rectify and eliminate the problem.

Everything you do, or must do, to ensure quality is being done because either a problem has already occurred or the process has been audited and the potential for a problem has been identified and steps must be taken to prevent that problem.

Safety first, quality second and efficiency last.