12/15/2016
They say the best way to learn is to teach, and for the first time ever, licensed laboratory technologists at URMC will do just that through a new clinical laboratory technology program.
The program will provide full-time clinical lab education for prospective medical technologists, with lectures and hands-on clinical training leading to an advanced certificate. The University and the New York State Education Department have approved the program, and it will welcome its first class of students in fall 2017.
Applicants must have a bachelor’s degree in the biological, chemical or physical sciences and have completed the coursework required for state licensure.
The University had previously partnered with Rochester Regional Health System (RRHS) to provide clinical training to students who received the lecture and exam portion of their training at Rochester General Hospital (RGH), but will now provide both facets of training on its own.
Vicki Roberts, program director and manager of education for the Department of Pathology and Laboratory Medicine, says the region needs every training program working at full capacity to fill a growing number of vacancies in the field.
“This is a benefit to the University and the region because it gives people who are unable to find a practical application for their degree entry into a licensed professional position,” Vicki says.
In 2006, New York State changed its licensing requirements for medical technologists (“med techs” or MTs). This law meant that staff who previously needed a B.S. degree in an applicable major must now complete 1-2 years’ worth of additional clinical training and pass a certification exam in order to be state-licensed.
While many MTs were “grandfathered” in when the law changed, others have balked at the new, more demanding educational requirements. This has made it more challenging than ever for employers to fill vacancies in the lab.
Leadership’s hope is that this new training program allows UR Medicine Labs to have a steady pipeline of trained, certified technologists to fill these vacancies as we grow and affiliate with more partners throughout the region—from Strong Memorial Hospital (SMH), Strong West and Highland hospitals, to medical campuses at FF Thompson in Canandaigua, Dansville, Wellsville and Hornell.
“UR Medicine’s need for additional licensed medical technologists could not be more urgent,” says Kathy Parrinello, chief operating officer of SMH. “This training program allows us to bring in current and prospective medical technologists to train in our excellent labs at SMH, graduate, and get their licenses so we can hire them into positions,” she adds. “We are grateful to Vicki and the entire team for their diligence and perseverance in bringing this program to fruition.”
The majority of lab staff at URMC is comprised of licensed MTs that work around the clock to perform a range of diagnostic tests. These tests help doctors learn what’s making patients sick and properly diagnose and treat them.
Med techs work in labs including Blood Bank and Transfusion Medicine, Microbiology, Chemistry and Hematology, Flow Cytometry and Bone Marrow Testing, Molecular Diagnostics, Surgical Pathology and more.
Geoffrey Harris (right) spent the last four years as Education Coordinator in the Hematology Lab. He’s one of many MTs that will serve as instructors in the new program.
“When everyone in a lab is an instructor and everyone teaches, it keeps people on their game,” Geoffrey says. “You realize this is a good thing for the whole lab and I think it makes everyone stronger.”
The new class will have between eight and twelve trainees who must complete 35 credits of non-clinical work and 720 hours of clinical experience before taking their certification exam.
People like Caroline Brown (right) know what it’s like to have a long path to licensure. She works in Clinical Microbiology, which is one of the largest labs at SMH—in terms of staffing and number of specimens.
When she started as a med tech at URMC, she simply had a B.S. degree. She took time off for family reasons and soon found that returning to work was not as easy as she’d hoped.
“In that timeframe, the licensing all came into being and I fell through the cracks,” Caroline says. “I had to do something in order to get back into the lab.”
She was accepted into the RRHS training program, which she completed, and later returned to UR as a licensed MT. Today she teaches trainees like herself who are hoping to grow their careers.
Teaching means MTs have new responsibilities on top of their regular workload, taking extra time and preparation to educate students.
For Caroline, that means strategically preparing live cultures days in advance so that students are able to simulate the work that licensed techs perform on a daily basis. This kind of prep is critical in making students’ experiences as authentic as possible so they are prepared to work in a lab.
Caroline says playing a part in this instruction is the best way to give back so others can have the same opportunity she did. “I feel for the future of the career in the lab,” she says. “We need people who want to learn and want to be here.”
The Medical Technologist program is now accepting online applications. For questions, contact Vicki Roberts at (585) 276-3688 or Vicki_Roberts@URMC.Rochester.edu.
7/13/2016
Have you ever wondered what happens to blood donations when they are taken to a hospital?
According to the American Red Cross, 6.8 million Americans give blood each year. The Blood Bank and Transfusion Medicine Unit at Strong Memorial Hospital receives and stores these blood products to be ready for patients around the clock.
We spoke with Debra Masel, Blood Bank chief supervisor, and Aimee Kievitt, lab supervisor, to learn more.
Where do blood products stored in the Blood Bank come from?
The vast majority of our blood comes directly from the American Red Cross located on John Street in Henrietta.
There is also a small donor room located off the main lobby at SMH where patients scheduled for surgery, and who qualify to donate their own blood, can have a unit of blood collected. This blood is then stored in the Blood Bank specifically for them if a transfusion is needed during their surgery.
What are the main functions of the Blood Bank?
We do testing to make sure that the blood received from the American Red Cross is compatible with patients who need it. If a patient has any type of transfusion issue, we need to identify and resolve the problem to ensure that the blood is truly compatible and that we’re not causing more harm by transfusing them.
Our attending physicians, nurses, residents and fellow provide clinical consultation on effective and safe use of blood transfusions, and evaluate transfusion reactions.
How much blood does the Blood Bank receive each day?
We transfuse about 100 units a day. During the blood collection process, approximately 500 milliliters of whole blood is collected which is then separated into red cell, plasma and platelet products. A unit of red cells has a volume of approximately 400 milliliters, which includes a preservative solution to increase the shelf life of the product.
What’s the difference between a blood sample and a blood product?
A blood sample is drawn directly from the patient and is used to complete pretransfusion testing to ensure compatibility with the intended blood product. Blood products are collected from volunteer donors.
A donation is separated into its component parts – plasma (55%), red blood cells (45%), and white blood cells and platelets (less than 1%) – which are each stored and used separately to help multiple patients.
What happens when there’s a trauma patient in the Emergency Department who needs blood products?
The Blood Bank has a trauma pager so when a Level 1 trauma patient is being transported to the hospital, the technologists are notified. They then prepare the trauma cooler with four units of O Negative (O-) uncrossmatched red blood cells, commonly known as the “universal donor.” When a staff member from the ED comes to pick up the blood, he or she will bring a patient blood sample for testing to be performed.
It is important to switch the patient to blood products identically matched to their own blood type as soon as possible, since our research at SMH shows that ABO identical transfusions are safer than use of “universal donor” red cells or plasma.
What kind of testing does Blood Bank perform?
The Blood Bank processes about 120 patient samples a day, many of which are outpatient samples for pre-operative and prenatal testing. About 90 percent of our transfusions are given to inpatients and the remaining 10 percent are transfusions received by outpatients.
What happens if a patient with very rare blood type needs a transfusion?
Sometimes there are other complications besides a patient’s blood type. If a patient has multiple antibodies, for example, finding compatible donors in the available blood inventory may not be possible.
In that case, we contact the Rare Donor Registry via the American Red Cross and a national search is initiated to identify a compatible donor. If we request something that’s available in the registry, they send it to us. We have gotten products from Florida, California, and other states.
What if the Red Cross can’t find what you’re looking for?
If we have a need for a rare unit and the American Red Cross has nothing in inventory, they can search their database to find a donor who matches the patient’s needs. They contact the donor and let them know that they are a rare match for a patient in need and request that they come to a center to donate.
How does a critical shortage in blood donations affect the work of the Blood Bank and Transfusion Medicine Unit?
In the event of a critical shortage (and it would have to be very dramatic) hospital administration and our attending physician and resident on call are notified. Our physicians and technologists will triage requests so that only clinically urgent transfusions are performed during the shortage.
The hospital chief medical officer may ask surgeons to reschedule elective surgeries so that the available blood supply can be conserved for urgent needs.
Thankfully, the community response to blood shortages has been good in bolstering the blood supply so that the drastic measure of rescheduling surgeries hasn’t happened in many years.
What’s a more common type of shortage you encounter?
When there’s a shortage of O- blood and the Red Cross can’t provide our normal inventory levels, we may need to evaluate every requested transfusion for clinical necessity and urgency.
It’s very important to obtain a patient sample as quickly as possible so that trauma patients receive products identical to their blood type instead of group O- blood. In those cases, it requires a higher level of communication and coordination between Blood Bank and the ED or Operating Room so we can appropriately supply their needs.
The same is true for platelet shortages. Our physicians, nurse and technologists evaluate each request for necessity and urgency. We discuss orders with providers to hold off on transfusion or reevaluate whether a transfusion is absolutely necessary when the necessity or urgency are not clear from the order.
When do you have the greatest need for blood donations?
Summers (around the Fourth of July) and December tend to be the two times when supplies are running lowest. Schools, which hold many blood drives, are closed, and people are on vacation so they are not available to donate blood.
What have been the biggest changes in blood banking within the last decade?
There has been a national push for restrictive transfusion practices, and this is a good thing. Blood transfusion can be lifesaving in certain situations but it’s not the cure-all. A transfusion is like a liquid transplant. If a patient doesn’t have a specific need to be transfused, they shouldn’t be.
Research performed here has led to substantial changes in transfusion practices to render them safer for the recipient, such as use of ABO identical transfusions, leukoreduced transfusions for all patients and washed transfusions for select patient groups. This has led to many fewer complications of blood transfusion and increased survival in some instances.
How has your role in patient care changed over time?
In the last decade, our staff has started to interact more directly with nurses and ordering providers to discuss patient cases; their underlying diagnosis, signs, symptoms, and whether transfusion is the most appropriate course of action. There have been more of those types of collaborative and educational discussions.
In photos:
Top: The Blood Bank at URMC stores all blood products in a cooler where staff can pull units needed for patients.
Middle: Lisa Hughes, a medical technologist, performs a test to determine the blood type of a patient who has received a bone marrow transplant.
Bottom: Medical technologist, Kim Bastian, releases a blood product to a patient for a transfusion. In this case, the patient has had transfusion reactions, so the product has been "washed" with saline to help prevent further reactions from occurring.
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7/13/2016
Congratulations to Tia Labarge, who has received the 2016 Rising Star Award from the American Society for Histocompatibility and Immunogenetics.
The award is given to an outstanding human leukoctye antigen (HLA) technologist who has worked in the field for less than three years and wants to pursue a career in HLA.
Labarge has worked at URMC since 2004 and joined the HLA/Tissue Typing Lab in 2014. Prior to this, she worked in other lab areas including Flow Cytometry and Microbiology.
In her current role, she is responsible for testing that will determine which patients will receive a solid organ or stem cell transplant.
Labarge will accept the award at the ASHI Annual Meeting in September.
6/29/2016
Have you ever wondered what happens to blood, urine, or other types of patient specimens after they are collected?
Specimen Management Services, or SMS, is a 24-7 operation of UR Medicine Labs. Its main headquarters is located on the ground floor of Strong Memorial Hospital, down the hall from the Emergency Department and Wilmot Cancer Center where patients are waiting on lab test results.
In addition to inpatient specimens processed at Strong, SMS receives many samples from outpatient facilities that include area nursing homes and 29 patient service centers across the Greater Rochester region.
Lab couriers pick up samples from these various outpatient sites and transport them to SMS collection points that include the SMS lab at Strong, a smaller SMS lab at the Ridgeland Road facility, Surgical Pathology, and Microbiology.
SMS, which includes Surgical Pathology, Accessioning, and Cytology, is the first point of contact for incoming specimens ranging from blood to urine, stool, spinal fluid, pap smears, and patient tissue samples.
Millions of specimens pass through SMS collection points each year. The lab at Strong processes over 8,000 specimens every day, with another 3,500 outpatient-only specimens delivered to Ridgeland Road.
The Microbiology specimen receiving area also receives specimens of all types for culture, while Surgical Pathology receives 465 surgical specimens – many directly from the operating room – on a daily basis.
“We’re the front end,” said Sue Hurlbutt, chief supervisor of SMS. “We’re the pre-analytical operations. We tell our staff to think about getting that sample out to the labs as if it belonged to you or your loved one.”
Once they arrive at SMS, each specimen sample is scanned by barcode and entered into an electronic database to be tracked.
The SMS lab in Strong is a beehive of activity with about 90 full-time-equivalent employees. On any given day, you will see technologists in white lab coats moving briskly with specimens in hand.
SMS technicians are non-licensed and cannot release final test results (these must come from a physician). Nevertheless, they play a key role in preparing each sample for final diagnosis.
“There’s a very technical aspect to the job,” said Scott Musial day shift supervisor. “There is a lot of work that goes into getting a specimen resulted.”
In order to be analyzed, most blood samples are put through an instrument called a modular pre-analytics system, or MPA. This spins each blood sample at high speed, separating it into its component serum and plasma.
Next, the samples are labeled, capped, sorted, and transported to another lab area for testing. Those that stay in the SMH laboratory for testing are strategically sorted and taken to another instrument to be analyzed.
Not all blood samples start at the MPA. Others needed for certain testing – hematology, coagulation, or toxicology, for example, will be delivered to the appropriate testing area and/or stabilized according to protocol for each laboratory.
Once logged and sorted, courier staff known as “scouriers” are responsible for taking samples to various in-house laboratories, like Microbiology, Flow Cytometry, or Cytogenetics, for specialized testing.
Many steps in specimen processing are high priority and time sensitive in nature. When Blue 100, Urgent or Stat tests come to the lab from Emergency and/or Cancer Center, turnaround time is extremely critical to ensure results are reported back as soon as possible so that patient treatment can be determined.
Outpatient testing is generally more routine, although healthcare providers will often ask for additional tests, known as add-ons, to tests that had been done previously.
As you might imagine, the workload for SMS is always a heavy lift. The team at Strong has managed to form its own sense of community through different efforts.
For example, SMS has a staff newsletter and large whiteboard where workers draw pictures, or start writing a story that’s continued by the next person.
Their “Ever Better Board,” or “E.B.B.” is a place where staff can share suggestions or offer feedback. The board was also featured in a university-wide training video as an example of best workplace practices, and staff celebrated the 200th E.B.B. post with a party.
“I think everyone works really well together,” said Musial. “Our group is relatively tight-knit. And although the lab seems big, you’re in a relatively confined space. You move through the same area and are working together each and every day.”
And by “every day,” he means just that. Even if the hospital loses power or extreme weather hits Rochester, SMS will stay open. They still need to service Emergency at Strong, and in inclement weather, that need is often greater than ever.
The fast pace is something Nathan Giles, a senior tech at Strong SMS, has grown accustomed to. Explaining the work of “the lab” to others can sometimes be difficult, he says, largely due to misconceptions about what happens to patient specimens.
When you see fictional doctors running their own lab tests on TV shows, it can seem like lab technologists are obsolete. The opposite is true. For doctors and nurses to start with the best information possible, it all starts in the lab.
“It’s not often that patients think about this part,” said Giles. “If I’d want them to know anything, it’s that we exist and that we’re a huge part of their treatment every day.”
In photos
Top: A technician prepares to place blood samples onto the modular pre-analytics system, or MPA, which spins the samples at high speed to separate them into serum and plasma.
Middle: Specimens arrive at the SMS lab at Strong Memorial Hospital via courier. Each sample is scanned by barcode into an electronic database so it can be tracked.
5/11/2016
UR Medicine Central Labs and UR Medicine Labs have been providing essential, behind-the-scenes services for sites across the U.S. participating in a clinical trial for cancer immunotherapy.
An Elmira man was featured in the local news because he was the first person enrolled at the Wilmot Cancer Institute to participate in the national clinical study of CAR T-cell therapy, which uses a patient’s own immune system to fight cancer. The trial is limited to people with certain types of lymphoma who have not responded to conventional treatment, and who meet strict eligibility criteria.
UR Medicine labs first partnered with a pharmaceutical company in 2015 to adapt and validate as assay for the presence and quantity of CAR19 T-cells in a patient’s blood, based on an a model developed by the National Cancer Institute. Since then the UR labs team has worked to refine and validate the assay for large-scale implementation.
The immunotherapy trial is designed to manipulate the body’s built-in defense mechanisms to fight cancer. Regular antibodies can be effective in fighting infection but are not so useful in killing tumor cells. Research has shown that a certain type of lymphocytes (a disease-fighting category of white blood cells) called T lymphocytes can target and kill lymphoma cells.
These "T-cells" must first receive permission from the body to fight, however. The patient's T-cells are introduced to DNA that first incorporates itself into their genome to produce a new protein – a chimeric antigen receptor (CAR) – that activates each cell, giving it the ability to detect and bind to a lymphoma cell.
"You're bypassing a lot of the regulatory checks and balances that have prevented previous attempts to generate tumor-killing T-cells," said Dr. Dan Ryan, director of Central Labs. "If (the cells) don't become activated, they die off."
Bill Crowe and Paul Rothberg from the Molecular Diagnostics Laboratory are leaders of the group that expanded the NCI test. Central Labs closely monitors test results from participating patient treatment sites across the U.S., and a vast network of lab professionals completes a series of time-sensitive steps.
Staff at Ridgeland Road assembles and sends out testing kits to each treatment site. The blood samples are then received via mail by Specimen Logistics staff six days a week. Technologists at the Tissue Typing Lab at Strong Memorial Hospital, Lymphoma/Leukemia Tissue Bank (SMH), Hematology Lab and Microarray Lab (Ridgeland) are responsible for processing and freezing all of the peripheral blood mononuclear cell blood tubes (PBMCs) for storage.
Phil Rock is a lab technician at SMH whose duties include tracking frozen samples for the CAR T-cell trial. He says the number of samples has skyrocketed since the trial began, which is a positive sign for immunotherapy.
"I think this trial, and the fact that (Central Labs) is growing is great for the department," said Rock. "I enjoy it immensely because having a hand in it allows me to use things that I went to school for and I've been trained to do that previously had no application."
In photos:
Top: Clinical tech specialist, Jonathan Hoffmann, treats PBMC samples in the Human Leukocyte Antigen (HLA) Laboratory at URMC. Middle: Dr. Dan Ryan, director of UR Medicine Central Labs, which coordinates participation in clinical trials. Bottom: UR Medicine Central Labs kit production coordinator Deidra Davis, left, and Morgan Devaney.
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