Overton Brooks VA Medical Center
National Medical Laboratory Professionals Week
As a part of National Medical Laboratory Professionals Week, the medical center is letting the secret out about its Laboratory Service.
“We’re one of the hidden areas of the hospital,” said Aubrey A. Lurie, MD, Chief, pathology and Laboratory Medicine Service. “That’s because we don’t have very much contact with the patient. It’s really all behind the scenes, but without a lab you cannot operate a hospital.”
“We’re the proverbial black box,” Dr. Steven Dauenhauer said, laughing. “The lab is where they test my blood,’ that’s what people think; then the sample goes behind ‘the swinging doors.’ The lay person doesn’t see what we do here.”
Dauenhauer, Director of Clinical Microbiology, supervises a section of the service that screens for bacterial infections, blood pathogens and intestinal parasites, to name a few. This area of the service also tests how well a patient’s antibodies are fighting an infection.
“The physicians see the patient’s symptoms and the lab shows the other half of the picture,” said Dauenhauer, “so we play a very vital and important role.”
Laboratory Service is also responsible for all patient testing with respect to tissues that are not limited to a specific “part” of the body, according to Anthony Tanner, Pathologists’ Assistant.
“For instance, we receive tissue and organ samples for diagnosis and, if necessary, cancer staging,” Tanner said. “The key to prevention is early detection. There are many screening processes in place for cervical and breast cancer; however, the current age for colon cancer screening is around 50 years old, even if the patient is not symptomatic, but I’ve seen advanced cancer in patients 20 years younger without significant family history of the disease.”
Tanner’s work requires a hands-on approach— cutting and dissecting pieces of tissue or whole organs and selecting the appropriate sections that will enable the Pathologist to render a diagnosis. It’s work that requires Tanner to perform and assist in autopsies conducted in the medical center, which is approximately 10 to 15 per year, according to Tanner.
Due to the sheer load of work Laboratory Service has to perform, not all of it can be performed manually. Much of the testing is automated, which includes work conducted by the Chemistry and Urinalysis Lab.
“We conduct so many tests that it would be impossible for us to do it by hand,” said Susan Dauenhauer, supervisor for Chemistry and Urinalysis Lab and wife of Steven Dauenhauer. “We have shifts that keep these machines going 24 hours a day.”
Mike Salinas, Chief Medical Technologist, says that the automated process is often taken for granted by those outside the service.
“People see that the tests are being put on analyzers, but there is a lot of time that is spent keeping these analyzers running,” Salinas said. “They make sure that these instruments are performing the way that they should, and if they’re not, they (laboratory staff) have to troubleshoot the problem. They’re under time constraints and they have to make sure that the results are accurate.”
As Chief Medical Technologist, Salinas operates as a “lab manager,” making sure that the clinical laboratory scientists who work in the service adhere to performance standards and that the work is conducted correctly.
Tanner, who performs his job manually, says that the automated processes in the laboratory are not as automated as many would probably think.
“It should be kept in mind that although the process is automated in giving you the results, the interpretation is not,” Tanner said. “You need a Pathologist and Medical Technologist for that.”
Although much of this work is conducted in the laboratory, the service also plays a role in testing the patient at the bedside.
“It’s called ‘point of care testing’,” Lurie said. “This testing is overseen by Wanda Huddleston. It has very strict controls and the results derived from that are very meaningful.”
“I train the nurses, physicians and other clinical staff on how to test the patient at the bedside,” Huddleston said. “It’s much more efficient to conduct a glucose test or another test that doesn’t require additional processing at the point of care. It helps us greatly to have that quick turn around.”
Laboratory Service also operates much like a school and is home to one of only three Schools of Medical Technology in the VA, serving as an internship program for Medical Technologists after they have completed the four-year degree portion of the program.
“Our school is independent,” said John Davis, Director of the School of Medical Technology. “Although many of our students come from Louisiana Tech, we train most of the community’s Medical Technologists.”
Completing the internship is just one of many hurdles future Medical Technologists have to overcome before entering the field as full-time professionals. Not only is a four-year degree and an internship required, those working in the hospital have to obtain a certification from the American Society of Clinical Pathologist and meet the requirements of the professional standards board, according to Salinas.
“There is so much training that our Medical Technologists have to go through before they’re allowed to work here,” Salinas said.
Laboratory Service also has rigors that it must pass to stay in operation. Like The Joint Commission, the College of American Pathologists inspects the service on a biannual basis, giving only a three-month window as to when they can arrive, according to Lurie.
“We have more than 3,000 inspection items that we have to be proficient in,” Salinas said. “There are numerous checklists and many of them overlap.”
Like all other services in the medical center, Laboratory Service requires a budget to operate. Leon Castaneda, Jr., Administrative Support Assistant, provides the administrative backbone of the service.
“My job is to monitor the supply budget,” Castaneda said. “These are special supplies such as serums and reagents that have to be ordered. I also manage all of the service’s 17 contracts as well as the time-keeping for the more than fifty people who work in the service.”
To those in Laboratory Service, the time, training and work pays dividends for the service’s reputation.
“We’ve established a tremendous trust with the public because they trust that their results are accurate and it’s a trust that is hard earned,” Lurie said. “We go through such strict training, inspections and accreditation. It’s one of the central kernels of the hospital.”
National Medical Laboratory Professionals Week, April 20-26, is a means to educate the general public on the important role laboratory professionals play in their health care as well as draw attention to the complexity of their training. The Pathology and Laboratory Medicine Service at Overton Brooks VAMC plays a part in the health and well-being of all of the medical center’s patients.