Collaboration in ICU medical rounds become reality
The COVID-19 pandemic has driven numerous changes in the clinical lab space, including those related to people, pro- cesses, and technology. While some have caused greater complexity, such as the need to diversify suppliers in the face of shortages, others have resulted in both clinical and operational benefits. Tyler Radke, MLS(ASCP), Team Leader, Laboratory, Bellin Memorial Hospital, Bellin Health Oconto Hospital, Oconto, Wis., describes how the pandemic prompted his lab to pursue what he calls a “wish-list” item, daily intensive care unit (ICU) medical rounds:
“Care teams and providers often reached out to the labo- ratory for guidance on test methodology, interpretation, and insights on COVID-19 testing. We also saw some test ordering patterns where we began to question the value being added. At one point, we even had a provider during Medical Care Branch call out the recommendation to consult with the laboratory regarding new assays being considered for COVID-19 patients. In that specific case, it was the use of Brain Natriuretic Peptide for monitoring ambulatory outpatients with COVID-19.” In response to these inquiries, Radke reached out to his facil-
ity’s Infectious Disease Provider to discuss the potential for a laboratorian to become part of the rounding team. “He was very supportive of the idea which then led me to connecting with the ICU Nurse Practice Specialist who coordinates daily rounds,” said Radke.
With their acceptance and support, Radke’s lab is in what he calls the “infancy stages” of his team participating in ICU medical rounds.
“Everyone on the team was very welcoming to including our laboratory,” he explains. “Within the first week, several team members had commented on the benefit of including the lab to review tests being ordered, send-out and culture results pending, and input on collection and testing proto- cols. I honestly didn’t expect there to be as much opportu- nity to contribute in the first week as there was, but the col- laborative environment was welcoming to the opportunity for improvement.” Radke said the biggest findings in the first week of the
lab’s participation in the ICU medical rounds were around canceling pending send-out tests
that they no longer
needed and recommending changes from ordering daily CBC with Differential to CBC No Differential. “In one case, the provider reduced the needs of lab test- ing from twice daily to ‘as needed,’ said Radke. “In conver- sation with the Nurse Practice Specialist, she has been very supportive as she felt the laboratory piece was mostly over- looked as the responsibility loosely belonged to anyone involved in the care management process. The collabora- tion and communication have been great. I am hopeful this will open the door to future opportunities for other areas to work with the laboratory.”
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