From May 3-6, 2011, over 200 Johns Hopkins Pathology employees from four Hopkins hospitals – Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, and Sibley Memorial Hospital – attended the American Society for Clinical Pathology (ASCP) workshops in Towson, Maryland. There were a total of 12 diverse, up-to-date topics offered during these four days, including leadership, microbiology, clinical chemistry, transfusion medicine, quality control, quality management, body fluids, LEAN – Sigma Six, to name but a few. For those who could not attend or would like to learn more about some of the workshops, 15 employees gave us a recap or evaluation on the workshops they attended:
5/3/2011 Reality in Transfusion Medicine
I was extremely grateful to have been given the opportunity to attend the ASCP “Reality in
Transfusion Medicine Workshop.” The speaker, Kathy Blaney, was extremely knowledgeable and presented in a way that was engaging, interesting, and informative. I felt that the issues discussed will help to enhance my professional development as a blood banker. All of the topics presented were relevant to the issues and scenarios faced in Transfusion Medicine today. Ms. Blaney discussed the reagents, new and old, that are used in the laboratory, as well as how to think creatively in difficult antibody work-up situations. Case studies of actual clinical situations were presented in which the antibody identified was either rare or not reacting classically. I found it useful to learn clues and testing techniques that can help lead to the identification of antibodies not often seen. We were also able to learn more about new blood banking technologies and automation. It was interesting to discover the differences and similarities of what is being utilized in Transfusion Medicine from colleagues in other laboratories, and discuss the pros and cons of each piece of equipment from actual experiences. The speaker also presented on how to distinguish and classify adverse transfusion reactions for reporting to national programs such as Hemovigilance. I believe that attending the ASCP workshops and conferences would be advantageous to those individuals seeking to learn more about topics in pathology. The knowledge, networking, and critical thinking skills I gained in this workshop will be invaluable to my career in Transfusion Medicine.
Priscilla Caldwell
Clinical Laboratory Scientist II, Transfusion Medicine
The Johns Hopkins Hospital
5/3/2011 Clinical Microbiology – Review and Update
This was a most impressive presentation. I extend many thanks to Johns Hopkins Pathology/ SMILE for providing the opportunity to participate in this year’s ASCP workshop. Both of the speakers, Drs. Sharp and McCarter, were excellent in their presentation styles and in their depth of knowledge. They were able to connect and interact with the audience from start to the end. They covered a wide array of Clinical Microbiology topics, including cutting edge techniques employed in clinical microbiology laboratories and an update on the recent emergence of clinical microbiology practices. A good example of the latter is the Gram staining method which appears very simple to most clinical microbiology laboratories, yet has long been considered the single most key criteria for accepting or rejecting specimens. The presenters also emphasized how to correlate Gram staining results with the final culture reports. To decide on work-ups of potential pathogen(s), the implication of Q-Score or Q/234 System is very interesting concept. Although clinical microbiology laboratories continue to practice reporting some potential pathogens in throat cultures, vaginal cultures and respiratory cultures, recent studies show that they have very little or no clinical significance. It is very helpful for clinical microbiology laboratories to implement rapid identification methods for bacteria and yeast which are based on CLSI guidelines. The culture work-up examples based on Gram stain and preliminary culture results were very interesting, and this exercise connected well with the audience.
Jalal Sheikh, PhD
International QA/QC Coordinator
Patient Safety Monitoring in International Laboratories (SMILE)
Johns Hopkins University Department of Pathology
5/3/2011 Quality Control: Utilizing Tracking & Trending to Anticipate, Identify, & Solve Laboratory Testing Problems
The use of Quality Control methods in the laboratory can accurately identify, solve, and predict future results. There are many variables that can affect the attempts of the laboratory to provide excellent care.
The Quality Cycle has three parts:
- The Pre-Analytic involves the proper collection and transport of the specimen to the laboratory.
- The Analytic is the quality control testing of the specimen.
- The Post-Analytic includes the recordkeeping and the personnel competency and evaluations.
Examples follow:
Preanalytic: In this stage, the sample collected has to be in the correct container and required temperature. It must be transported within the appropriate time frame.
Analytic: This includes laboratory management of the equipment and control reagents, and use of the Levey-Jennings chart which shows a graphical method for displaying control results and evaluating whether a procedure is in control or out of control. Lines are drawn from point to point to accent any trend shift or random excursions.
Post-Analytic: The Laboratory can plot results using the Levey-Jennings chart to make decisions regarding the precision and accuracy of the assay to provide reliable results. It does the tracking which is looking at data for a period of time, and trending the movement of the data points in an upward or downward direction.
It can be used to show trends for personnel competency and evaluations. These charts are reviewed at defined intervals, necessary action taken, and documented.
Barbara Rookwood
Clinical Laboratory Scientist I, Core Laboratory
Johns Hopkins Bayview Medical Center
5/4/2011 Excelling in Leadership
I am currently not in a position as a Lead, Supervisor, or Manager, but I took this workshop to use as a future tool. My goal is to be a Supervisor and/or Manager in the near future. I found this workshop uplifting and to the point. It had a lot of great ideas to better oneself and how to work with your Team. It was geared toward Leadership for any type of facility/situation so it had a lot of “Take Home Points.” The program made you think about how you perceive yourself and your staff which then led to discussions on how to better advise and motivate your staff. The presentation was helpful on ways to approach all different types of peoples to make everyone feel comfortable about what needs to be addressed. The presenter also had great “Ice Breakers” for groups to do to get to know your staff/audience. The workshop also had great suggestions on how to approach progressive discipline, sticky situations, and how to recognize and reward excellent staff members.
I would recommend this presentation to others who want to be or who are in a Supervisor/Manager position. It was a great workshop and I am grateful for the chance to go.
Melissa A. Neally
Clinical Laboratory Scientist III, Transfusion Medicine
Johns Hopkins Hospital
It was a blessing for me to attend the workshop on Excelling in Leadership, a well-presented lecture by an excellent speaker, Josie Foranoce, the Laboratory Director of Florida Hospital Altamonte. The lecture was very informative and will help accomplish my goal to be a better leader and team player in our workplace. Applying the values and principles of a good leader will help us interact better with our peers which will result in quality customer service and excellent patient care.
Cyrene Abcede
Clinical Laboratory Scientist III, Transfusion Medicine
Johns Hopkins Hospital
5/4 Hematology Lymphocyte Morphological Challenges
This lecture was very thorough and informative! Steven Marionneaux, who was the presenter, was very knowledgeable concerning lymphocyte morphology/classification. He went through the morphological stages of lymphocytes (normal lymphs, reactive lymphs, abnormal /variant lymphs, plasma cells, monos, blasts, etc.), and presented “real life” case studies that correlated with the viewed cells. He provided helpful hints in relation to confirming different cell lineages. Finally, he linked the didactic experience to different labs in pathology (immunology, flow cytometry, special hematology) and genetic testing. Steven’s sense of humor and personable demeanor allowed him to interact effectively and engage fully with the lecture attendees. I highly recommend this lecture to other medical laboratory scientists!
Kathleen T. T. Lewis
Supervisor, Immunology Laboratory
Johns Hopkins Hospital
Steven Marionneaux is a very engaging, articulate speaker who has a passion for what he teaches. The class reviewed stages of lymphocytes using slides, diagrams, and case studies. Differences between leukemias and lymphomas were covered, as well as other diseases where reactive lymphocytes are found. Steven made a point of going over very difficult cells – those that blur the line between different stages. He also went over the flow cytometry markers of the different diseases. The handouts will be very valuable for later reference. I’d highly recommend this instructor for any med tech. Even for those with a lot of experience in cell morphology, it is very good review of difficult cells.
Mark Swartz
International QA/QC Coordinator
Patient Safety Monitoring in International Laboratories (SMILE)
Johns Hopkins University Department of Pathology
5/4/2011 Review of Selected Topics in Clinical Chemistry
This workshop covered a wide variety of topics, including discussions of pre-analytical, analytical, and post analytical errors, with suggested strategies on how to minimize errors. We also reviewed topics in toxicology, including DUI and therapeutic drug monitoring, discussed laboratory evaluation of hepatic and pancreatic function, and learned about the current guidelines for carbohydrates and evaluation of diabetes. We discussed pharmacogenomics and how genetic make-up may affect the way a drug reacts with a certain population. We also discussed the evaluation of multiple myeloma and Alpha-1-antitrypsin deficiency.
The instructors were extremely knowledgeable and presented very extensive and complicated material in a well-organized and understandable way. We covered a huge amount of information in very little time. I learned a lot about each of the chemistry topics. I was especially interested in the discussion of the pre-analytic, analytical, and post-analytical errors in laboratory testing and the impact it has on patient treatment. The information was fresh and useful. I sincerely learned a lot from the information presented.
Gwendolyn Artis
Clinical Laboratory Scientist III, Core Laboratory
Johns Hopkins Bayview Medical Center
5/5/2011 9328: Phlebotomy Ps and Qs
The Phlebotomy ASCP Workshop (Phlebotomy Ps and Qs) was very informative.
As a Lab Tech2/Phlebotomist at HCGH/JHH, this workshop did meet my expectation for professional development needs. Karen Brown was an exceptional instructor/speaker for the event. I found her presentation and material very well organized and understandable.
Larisa Feinstein
Laboratory Technician II/Phlebotomist
Howard County General Hospital
5/5/2011 Body Fluids Morphology: The Good, the Bad, and the Ugly.
I attended the workshop entitled Body Fluid Cellular Morphology. Our presenter, Mrs. Jill Smith, was very knowledgeable of the subject and presented it in a manner that was easy to understand. The main objectives of the workshop were as follows: (1) specimen handling; (2) optimum slide preparation; (3) to distinguish between the characteristics of normal and abnormal cells observed in cerebrospinal, pleural, peritoneal, pericardial and synovial fluids; and (4) to present a systematic approach for distinguishing the differences in benign, reactive, and malignant cells in body fluids. Case studies were presented to reinforce what we had learned. Mrs. Smith emphasized that accurate cell identification is dependent on proper specimen handling and optimum slide preparation. CSF, amniotic fluid, and synovial fluids should be examined for cellularity within one hour of collection as cell lysis occurs rapidly in these fluids. Fluids from the pleural, pericardial, and peritoneal cavities should be examined as soon as possible after collection, but satisfactory smears can be made up to 24 hours if stored in the refrigerator. The latter fluids are ultrafiltrates of plasma and, therefore, their cell membranes are more stable. Proper slide preparation is vital as mentioned. A good cytospin slide must show ample cellularity, should accurately reflect the reported cell counts and should exhibit a monolayer of cells with minimal gaps or spacing. Various techniques can be employed to ensure optimum slide quality depending on the fluid consistency, i.e., fluids with fibrin strands or large proteins can be washed with saline, fluids with fibrinous clots can be gently agitated to free trapped cells, bloody fluids can be diluted and mucolytic agents can be added to a mucoid or highly viscous sample such as a synovial fluid. Once the slide is prepared and stained, the entire cellular area of the cytospin prep should be scanned using the low power (10X) objective to ensure that small numbers of malignant or other abnormal cells are not overlooked. The importance of this was made clear when Mrs. Smith told us of a case where an entire slide was scanned for a particular patient, and not until the very last field did they discover three breast carcinoma cells. Had the entire slide not been scanned, this patient may have been misdiagnosed. (The presenter even had a program which allowed us to actually scan an entire slide on low and high power).
One tool that Mrs. Smith uses in her laboratory that I found to be very interesting and very valuable was a simple DIGITAL CAMERA. The camera can be used to obtain images directly from a microscope. First, you lower the light on scope and turn the flash off on the camera. Then place the camera lens directly onto one of the microscope oculars, zoom in and take a picture of the cell in question. This can be very useful if a supervisor/pathologist is not available to review a slide and can also be used for training/education purposes. The video function of the camera can be used as well. Mrs. Smith demonstrated this by showing us a video that was taken from a CSF on a hemacytometer. We could see an actual amoeba moving throughout the fluid. Although this was awesome to see, it was disturbing to know that someone had an actual amoeba floating around in their CSF. Unfortunately, I believe she did say this case was fatal.
Case studies were presented throughout to help distinguish between benign, reactive and malignant cells. Each class participant was given a remote control and was able to answer questions and identify cell types anonymously. I liked this because everyone was able to stay engaged in the presentation by active participation. Also, it saved everyone from embarrassment if they did happen to answer a question incorrectly.
As stated above, our presenter was very knowledgeable of the subject and presented it in a very interesting manner. I learned some very valuable information and hope to be able to utilize it in the future. Overall, the course was very informative and the presenter did an excellent job. The only suggestion I have is in the future if more “normal” cases are reviewed as well. It was interesting to see cases associated with ALL, CLL, other malignancies, etc ., but that is not what is typically encountered on a daily basis in the laboratory.
Kendra Wilson
Lead Medical Technologist, Core Laboratory
Johns Hopkins Bayview Medical Center
5/5/2011 LEAN, Six Sigma, Root Cause Analysis, & More: Taking the Mystery Out of Process Improvement Tools
It’s surprising how much information we can acquire, yet do not put into practice. The ASCP workshop on process improvement was enlightening, and can be helpful and useful only when properly applied in real lab situations. From eliminating wasteful processes to improving physical arrangement to identifying systems/machines that maximize work effectiveness, this workshop hit the mark. Hopefully, our lab will be able to properly implement these to benefit us (techs), and management.
Krystelle Banno
Clinical Laboratory Scientist II, Immunology Lab
Johns Hopkins Hospital
The “Lean, Six Sigma, Root Cause Analysis, and more: Taking the Mystery Out of Process Improvement Tools” workshop was informative. Although the concepts are not new, it was refreshing to have an overview of the various tools available and tap into new opportunities for process improvement.
In the light of the current economic challenges, the practical application of the ideas presented will aid us in our continued quest for innovative ways to achieve more positive outcomes.
Arden G. Bongco
International QA/QC Coordinator
Patient Safety Monitoring in International Laboratories (SMILE)
Johns Hopkins University Department of Pathology
5/6/2011 The Elements of a Quality Plan
The workshop “The Elements of a Quality Plan” was very informative. The lecturer covered every aspect of an excellent Quality Management Plan. Each part of the plan was clearly defined and also with informative handouts, procedures, and templates. The Jeopardy games were entertaining and a fun learning experience.
Kitty Selitto
POCC/ Laboratory Specialist
Department of Pathology
Howard County General Hospital
5/6/2011 Hemostasis in the Clinical Laboratory
The ASCP workshop on hemostasis was an excellent and comprehensive review of coagulation and the importance the laboratory plays in patient care. The speaker was very knowledgeable in the content that was discussed and allowed several opportunities for questions from the audience which were answered very thoroughly. She discussed not only the importance of the lab results and how they relate to patient diagnosis and treatment but also the thought process that should be involved in choosing the appropriate test and making the next decision to come to the correct conclusion. I personally do not work in the lab so I found that the afternoon discussion was not directly related to my everyday job, but nonetheless found it interesting.
Kristin Uglik
Transfusion Coordinator
Hemapheresis and Transfusion Service (HATS)
Johns Hopkins Hospital
5/6/2011 Molecular Methods in the Clinical Laboratory
The ASCP seminar on Molecular Methods in the Clinical Laboratory met its objective in offering a comprehensive introduction to molecular diagnostic applications. The speaker was very knowledgeable and discussed the appropriate use of molecular testing methods; she also discussed the advantages and disadvantages of various molecular assays and platforms. I would recommend this seminar to anyone who is interested in updating their knowledge in Molecular Methods, or considering adding molecular methods to an existing laboratory.
Sharon Cherie
QA Medical Technologist, Continuous Quality Improvement (CQI)
Department of Pathology
Special thanks to all of the Pathology employees who took the time to contribute to our Blog and share their experiences with us.