Ask the Expert with Barry Craig | February 2013

Barry Craig is a physician office laboratory (POL) and diagnostics expert. With over 20 years of lab consulting experience, Barry helps practices develop in-house labs as a place to obtain fast, accurate lab results and maintain a healthy profit.  Each month, Barry answers questions from POR Magazine and Blog readers.  Here is a selection from this month's questions.

My service contract expires next month on my analyzer. It was free for the first year of our five year lease. Do I have to renew the service contract? It cost a lot of money and the instrument is running great.

“My instrument is running great” is probably the worst jinx you could possibly do to yourself. Take that line back while you still can! With that being said, renewing the service contract depends on a few things.

  1. Does the contract include required preventive maintenance? If it does, then you will have to renew the contract.CLIA regulations state that maintenance must be performed as often as deemed by the manufacturer. If the preventive maintenance performed is not something that can be done by the end user, then the contract will have to be renewed.
  2. How old is the instrument?  If preventive maintenance is not required, the next aspect is the age of the instrument. If you purchased your instrument outright and it is at least five years old, or if you are at the end of your five year lease, I would probably not renew the service contract.

For most analyzers, the usable lifespan is about five years. Don’t get me wrong, I have seen hematology analyzers rock along for ten years, but, generally speaking, five years is an average lifespan before a machine starts spitting parts and running backwards. At the five year mark, if the analyzer has a major breakdown, it is generally better to go ahead and replace the instrument than to foot the expense of the repairs or service contract.

My coworker is constantly removing her shoes and walking around the lab in her sock feet. She says her shoes get uncomfortable by the end of a long day. I think it is gross. Can she do this?

Eeeewww. Not a good idea. There are all kinds of nasty things on a lab floor, in addition to possible small pieces of glass or other puncture prone items. This is not allowed by OSHA regulations. Shoes must be worn and should be close toed. No flip flops or sandals.

That being said, here is a short list of other lab no no's:

Eating and drinking – How about a little Staph infection with that sandwich? This is a big one. No food or drink of any kind should ever be in the lab area. This includes gum, mints etc. Lab inspectors love going through drawers and cabinets looking for contraband.

Cosmetics, hair products, etc. – Where you work is not the Salon’ de Lab. When you layer on makeup in the lab, you could also be sealing in a nice layer of bacteria. All of these products should be elsewhere. Most offices have a restroom just for employee use. This would be the place for these items. I am so lucky to be a guy. Enough said.

Artificial nails – Studies have shown that artificial nails are a breeding ground for bacteria in a healthcare setting. The bacteria can invade the spacing between the natural and artificial nail.

Some healthcare facilities have regulations in place prohibiting artificial nails, others do not. Personally, having seen firsthand the infections from this, I would go with my natural nails.

My results from my chemistry analyzer are not matching with the reference lab results. My analyzer is working well, it is well maintained, and calibration and controls are good. Why are the results different?

This is not uncommon. The main reason is usually not that your instrument is wrong or malfunctioning. Most likely it is a difference in methodology. Large, reference lab instruments use completely different methods to perform the testing than from your analyzer. Sometimes the method differences lead to different normal ranges. For instance, if you perform a PSA test in your lab using a small, benchtop analyzer, you may get a result of 1.1. The reference lab, using a different methodology and instrument may get a 1.6. This does not mean your machine is in error. The reference lab will have a normal range based on their methodology that matches their result.

Just to note, I did receive a nice email from someone regarding a previous article I did a few issues back. It was about being active in the political process that shapes healthcare and using your voice to shape these changes. The person emailing said I inspired her to write her congressional representatives and let them know how she felt about the healthcare issues.

The fact I inspired anybody to do anything is amazing to me. I did inspire several people to leave a karaoke bar once. 

But, again, make your voice heard. One voice, one vote can make a big difference. Wherever you stand on healthcare, this is a time of great change and upheaval.

Barry Craig

 

Expert on physician office laboratories and diagnostic equipment

Barry works almost exclusively with POLs and understands the needs and challenges they face. With more than 20 years of lab consulting experience, his company works with office lab start-ups, inspection follow-ups, and help with the CLIA, COLA and JCAHO regulatory issues offices face daily. He offers a unique insight and customer focused approach to the lab and its solutions. In his current role as President of Laboratory Consulting, LLC, Barry is leading the way for physician's offices to develop their in-house labs as a place to obtain fast, accurate results and maintain a healthy profit using the latest technology available.

Being in touch with the POL community nationwide his company has a unique insight into the problems and questions that arise from the operation of a POL.

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