New Technology Deploys in Laboratories

Achievements Spotlighted to Celebrate Laboratory Professionals Week

It’s been a busy year for our laboratory professionals. They’re a critical piece of the “Serious Medicine” we provide, as so much of our treatment decisions rely on the information our laboratories provide.

The Sysmex automated Hematology line can process 300 CBCP samples per hour.

One significant advancement was made last year, when the Core Lab was able to expand a crucial offering for patients who may be bleeding internally.

It’s called viscoelastometry (or TEG) and for years, we offered this testing outside the ORs at Nebraska Medical Center. But there were many barriers to utilizing the equipment, including time-intensive set up and that physicians had to leave the OR to review the test results on a paper report.

As Nebraska Medical Center worked to earn its Level 1 trauma designation, leaders knew in order to achieve this, TEG testing must be offered 24/7 and at many locations, not just outside the OR.

If a patient is bleeding, physicians are able to treat it by giving the patient one of four blood products:  plasma, red blood cells, platelets or cryoprecipitate.

“There are many different reasons that would cause a patient to bleed,” says Pathologist  Scott Koepsell, MD, PhD. “Before this technology, a physician would have to make an educated guess as to what blood product would stop the bleeding. This technology allows a physician to view the test results in real time, to understand exactly what blood product the patient needs.”

Medical Laboratory Scientists Trish Hansen, Jane Larson, and Jessica Price at the REMI command center.

Dr. Koepsell says not only does this protect the patient from potential harm by giving them a blood product they don’t need, it also conserves the blood products our community donates, which is a precious resource.

After the lab receives a sample of the patient’s blood through the pneumatic tube, they have a two-hour window to test the blood, and the test runs for 60 minutes.

“This test takes priority over everything else,” says Valerie Henry, lead medical lab scientist, Core Lab. “As the test is running, it generates pieces of data every five minutes. This is meaningful information a physician can see where they may be – the OR, a trauma bay, or the ICU.”

Our specialists, like cardiologists and neurologists, who have patients using stents can also use TEG to determine how well the blood-thinning medication is working.

“Before, the only way doctors knew a medication was not working is if the patient suffered a serious adverse event, like a stroke,” says Dr. Koepsell. “Now, they can see right away if a patient is not responding to a medication and to make adjustments to keep the stent open.”

Another example of improved patient safety involves patients who are on bypass.

“Before a patient could go to the OR, they had to wait days for their blood thinners to wear off,” he says. “This technology can pinpoint exactly when it’s safe to take the patient to the OR.”

We have four TEGs, which can run two tests at a time, that are always running.

Medical Laboratory Scientists Erin Koziel and Gina Le in the differential area.

Three went live May 2017 and the fourth went live in August 2017.

To validate the TEG, Henry drew samples of her colleagues’ blood and sent samples through the pneumatic tube system, while walking additional samples to the Core Lab.

“We needed to know if the pneumatic tube would compromise the blood,” Henry says. “Fortunately, it did not.”

The feedback from lab scientists and physicians has been very positive.

“The first month we conducted 50 tests, the following month, we performed approximately 200 tests,” says Henry. “It demonstrates how fast the news of this valuable testing spread among our physicians.”

Research also shows the added safety measures this technology provides reduces the average patient length of stay by three to four days.

Another cool new testing technique will go live this summer in the Microbiology Laboratory. It’s called matrix assisted laser desorption/ionization (MALDI) and it’s designed to identify bacteria incredibly fast.

Currently, if a culture is sent to Microbiology to identify a possible bacterial infection, the lab technologists will wait for the bacteria to grow and then analyze and identify it.

“Depending on the culture, it could take hours, even weeks to identify the bacteria,” says Dr. Koepsell.

Chastity West, lead medical laboratory scientist, seen reviewing data from MALDI, has been working with Caitlin Murphy, PhD, assistant medical director, to validate the instrument.

With MALDI, the turnaround time will be reduced to minutes.

Dr. Koepsell describes the new technology as “using a laser to blow up bacteria to identify it.”

“Every bacteria blows up differently,” he adds.

MALDI features an FDA-approved instrument panel with different methods to identify a variety of bacteria.

“This will give physicians a much better idea of what antibiotic can be used to treat the bacteria,” says Amy Crismon, Laboratory manager.

This also supports our mission of antibiotic stewardship and protects the patient from unneeded antibiotic treatment.

“We’ve wanted this for years,” adds Crismon, “We’re pretty darn excited.”

The Microbiology Lab will complete the MALDI validation very soon and then conduct training and competencies in May.

 

To schedule an appointment with a specialist at Nebraska Medicine, call +1-402-559-3090 or OIHS@nebraskamed.com.

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