Laboratory Management
General Laboratory Management. Fellows will attend the weekly laboratory administrative meeting at BIDMC (Wednesday 10 am to 11 am) and contribute to discussions of all administrative matters including personnel issues, quality assurance issues, and consideration of new methodologies. This weekly work meeting is attended by the microbiology attendings, laboratory manager, lead technologists and microbiology fellow(s). During the yearly budget process, they will learn how to set up a budget for the laboratory. Every other year, they will participate in a CAP inspection of another laboratory and review material needed to become a competent inspector. They will read and understand the CLIA’88 law and its amendments. They will become familiar with the multiple CAP checklists affecting the clinical microbiology laboratory and help us ensure through self inspection that we fulfill all checklist criteria, old and new. They will participate in meetings with vendors related to consideration of new methods, or reconsideration of current methods. They will learn how to cost account methods (reagents, technologist time, indirect costs) and observe the negotiation process during the contracting process. They will participate in providing cost-effective medicine and review with clinicians directly or indirectly (by advising microbiology residents) the need for expensive (and potentially medically unnecessary) send-out tests. They will learn about laboratory design. They will learn about the process of hiring new technologists (job descriptions, interviewing), ongoing evaluation of technologists, workload assessments, and ways to foster excellence. Fellows will perform an OSHA self-inspection.
Annual Laboratory Management Course. We have a separate, departmental course in laboratory management, which will be attended by the microbiology fellow and pathology residents. This course includes sessions on risk management, budgeting, billing, compliance, contracting, CLIA’88, validation and verification of assays, quality assurance, quality control, statistics for laboratorians, accreditation, and laboratory inspection. Generally participants choose or are assigned a test and will research and present relevant aspects to the group as we progress through each session (budget, reimbursement, QC/AQ, verification, inspection, etc.). The course is taught by laboratory medicine attendings from the various clinical laboratories at BIDMC and led by Clinical Microbiology faculty member, Stefan Riedel. Fellows may give a small number of lectures related to microbiology laboratory management. For example, a previous fellow gave the antimicrobial susceptibility and biosafety in the microbiology laboratory lectures. Link to the 2022-2023 Laboratory Management Courses Schedule.
Quality control and quality assurance programs. Fellows will participate in the selection of quality assurance metrics (e.g. blood culture bottle weight, Gram stain corrected reports) and review data along with attendings. Fellows will review final results from CAP surveys and give educational feedback to the laboratory. Fellows will review ongoing quality assurance activities, for example, QC of susceptibility testing methods, and develop a complete understanding of quality assurance measures in the microbiology laboratory as specified in CLIA’88, CLSI standards, and Cumitechs. We will challenge the fellows to find areas of quality improvement in our laboratory.
Fellows will help in the revision of our online laboratory manual and the educational comments in our physician order entry system, in an effort to educate clinicians about optimal testing practices (specimen type and requirements, sensitivity and specificity of tests, limitations, expectations, alternatives, and ongoing experience with testing especially as related to esoteric send out testing.
Fellows must learn and demonstrate an ability to implement a laboratory quality control and quality assurance program. As part of the quality assurance program, fellows will learn and be able to apply the use of statistical methods (including but not limited to sensitivity, specificity, positive predictive value, accuracy, precision, and methods to verify and validate the same for both quantitative and qualitative assays).
Fellows will attend weekly laboratory medicine conference and pathology department "M&M" conferences where management and quality assurance activities in clinical laboratory practice are discussed. They will participate in root cause analysis and presentations as appropriate, with an expectation of one M&M presentation per annum.
LIS/Computer training (ongoing): Fellows will learn use of computer programs to interrogate our clinical databases to identify trends in sentinel organism detection and antimicrobial resistance patterns (e.g. MRSA rates). At the present, we use the WHONET program available from the World Health Organization; other avenues of data mining will also be investigated as we migrate to new systems in future years. Fellows will become familiar with the front-end physician order entry systems and make suggestions as to appropriate menus to optimize ordering practices. They will participate in developing educational comments in the order entry system and will help update the on-line laboratory manual. We are migrating to EPIC/Beaker and fellows will learn how to become facile with this pervasive HIS/LIS system.
Ethics And Safety Training. Fellows will take institutional training in the responsible conduct of research and HIPAA training via the CITI program discussed elsewhere. At the beginning of the academic year, fellows will attend a required departmental training sessions including OSHA, blood borne pathogen, biohazard safety training, chemical safety, and fire safety.
Annual Laboratory Management Course. We have a separate, departmental course in laboratory management, which will be attended by the microbiology fellow and pathology residents. This course includes sessions on risk management, budgeting, billing, compliance, contracting, CLIA’88, validation and verification of assays, quality assurance, quality control, statistics for laboratorians, accreditation, and laboratory inspection. Generally participants choose or are assigned a test and will research and present relevant aspects to the group as we progress through each session (budget, reimbursement, QC/AQ, verification, inspection, etc.). The course is taught by laboratory medicine attendings from the various clinical laboratories at BIDMC and led by Clinical Microbiology faculty member, Stefan Riedel. Fellows may give a small number of lectures related to microbiology laboratory management. For example, a previous fellow gave the antimicrobial susceptibility and biosafety in the microbiology laboratory lectures. Link to the 2022-2023 Laboratory Management Courses Schedule.
Quality control and quality assurance programs. Fellows will participate in the selection of quality assurance metrics (e.g. blood culture bottle weight, Gram stain corrected reports) and review data along with attendings. Fellows will review final results from CAP surveys and give educational feedback to the laboratory. Fellows will review ongoing quality assurance activities, for example, QC of susceptibility testing methods, and develop a complete understanding of quality assurance measures in the microbiology laboratory as specified in CLIA’88, CLSI standards, and Cumitechs. We will challenge the fellows to find areas of quality improvement in our laboratory.
Fellows will help in the revision of our online laboratory manual and the educational comments in our physician order entry system, in an effort to educate clinicians about optimal testing practices (specimen type and requirements, sensitivity and specificity of tests, limitations, expectations, alternatives, and ongoing experience with testing especially as related to esoteric send out testing.
Fellows must learn and demonstrate an ability to implement a laboratory quality control and quality assurance program. As part of the quality assurance program, fellows will learn and be able to apply the use of statistical methods (including but not limited to sensitivity, specificity, positive predictive value, accuracy, precision, and methods to verify and validate the same for both quantitative and qualitative assays).
Fellows will attend weekly laboratory medicine conference and pathology department "M&M" conferences where management and quality assurance activities in clinical laboratory practice are discussed. They will participate in root cause analysis and presentations as appropriate, with an expectation of one M&M presentation per annum.
LIS/Computer training (ongoing): Fellows will learn use of computer programs to interrogate our clinical databases to identify trends in sentinel organism detection and antimicrobial resistance patterns (e.g. MRSA rates). At the present, we use the WHONET program available from the World Health Organization; other avenues of data mining will also be investigated as we migrate to new systems in future years. Fellows will become familiar with the front-end physician order entry systems and make suggestions as to appropriate menus to optimize ordering practices. They will participate in developing educational comments in the order entry system and will help update the on-line laboratory manual. We are migrating to EPIC/Beaker and fellows will learn how to become facile with this pervasive HIS/LIS system.
Ethics And Safety Training. Fellows will take institutional training in the responsible conduct of research and HIPAA training via the CITI program discussed elsewhere. At the beginning of the academic year, fellows will attend a required departmental training sessions including OSHA, blood borne pathogen, biohazard safety training, chemical safety, and fire safety.