This exhibit features 50 amazing images and corresponding descriptions from the newly published book by Pathology faculty, Norman Barker and Dr. Christine Iacobuzio-Donohue. Over 60 medical professionals, including many from Johns Hopkins, contributed to this book with the same title, Hidden Beauty: Exploring the Aesthetics of Medical Science. The book cover is unusual because on close inspection you realize this beautiful image is actually a mound of gallstones.

Each of the exhibit’s works is fascinating, very wonderful, and engaging to the viewer. Many of the images are visually stunning patterns of different diseases that affect mankind. One leaves the exhibit with a great appreciation for biology in general, the wonder of the human body, for medical scientists, the study of the particular type of science they have dedicated their lives to, the technology or talent that enables us to see the image, and last but certainly not least, the artistry behind the image.

The description provided for each picture helps the viewer to better understand and appreciate the subject matter, the science, why it was chosen, and how it was created. Because it is impossible to fully describe these beautiful images and because of space constraints, I will provide an brief overview

The spectrum of these extraordinary medical science images is far-ranging — from an engaging electron microscopic images of telomerase, to a colorful photo of an actual research bench with its descriptive analogy of a work bench being similar to the kitchen in a busy restaurant, to the very sad and poignant bone scan of patients with metastatic prostate cancer. A “nude” mouse is featured in one selection because these naturally hairless creatures are invaluable to certain types of research because they do not mount a rejection response to human tumor grafts.

The kidney images were taken with a scanning electron microscope and a transmission electron microscope that can magnify 400x to 10,000X and depict the most detailed imagery available. The human brain image is fascinating — a 400X magnification of neurons, dendrites and axons. The nine images of the human eye, one normal and eight diseased are exceptional. Other presentations include extraordinary images of gallstones (featured on the book cover), HIV, osteoporosis, DNA sequencing, TB bacterium, Pap smear, tissue microarray, the placenta, salmonella, Max Broedel’s illustration of the inner ear, much more.

Download the poster here.

Look below to see some of the imagery from this exhibit (click for larger) which runs until Friday, May 31. Please do not miss it!

Renata Karlos
Staff Assistant
Department of Pathology

The new Core Lab in the Sheikh Zayed Building is huge and open, yet there is a feeling of closeness with coworkers because of the convenience of having many work areas near each other.   One can see the whole process from beginning to end.  This gives the Core Lab staff and leadership opportunity to change, improve, and implement processes for quality laboratory reporting.  Additional space can accommodate continuing increases in laboratory work volumes. No matter how busy it gets, the effective acoustic materials on floor and ceiling make for a quiet lab.  Coupled with appropriate illumination and green color scheme, the lab is a calming work environment.

A view of the Core Lab

Additionally, the Critical Care Lab is now located on the 5^th floor of Zayed in close proximity to the operating rooms.

Critical Care Lab on Zayed 5

Although change can be difficult and training on new instrumentation challenging, the newness and good safe design of the Core Lab and offices inspire excitement.

Core Lab Roche Modular instrumentation

DSX (best2000®) automated ELISA processor and plate reader in Special Coag

Loading the Roche MPA

Processing at the Sysmex HST automation line

The new suite of offices and other offices encircle the lab allowing close personalized communication between staff and leadership.  New restrooms, a new break room, and new conference rooms are amenities our faculty, staff, students, and visitors enjoy. In particular, everyone has enjoyed the conference room that opens to the break room.  This new double room allows space to eat and mingle during large events.  When it is time for education, the conference room is closed off from the break room and presenters use up-to-date audiovisual equipment for their sessions. In addition to the conference room, there is a library and a lead technologists’ conference room, making it easier to schedule a meeting/conference room and prepare the room for events on all shifts.

Transfusion Medicine

The new Transfusion Medicine Laboratory is located in the Sheikh Zayed Tower on the third floor.  The new lab is in close proximity to all ORs including Weinberg, Cardiovascular, Neurology, Children’s, and Obstetrics.  The TM Lab is one large facility that encompasses the testing areas, administrative offices, rooms for educational programs for the staff, SBB and university students, a walk-in refrigerator and a supply room. The reference lab is now in close proximity to the main lab to facilitate better communication amongst all staff members creating efficient and timely completion of antibody work-ups.

The move to the Zayed Tower has allowed for the implementation and use of Hemosafe in the ORs.  The Hemosafe is similar to a vending machine for blood products, which allows for quick and easy remote allocation on demand for patients.  The Hemosafe has been a positive addition to help reduce volume of manual preparation, selection and crossmatch of blood products for patients in the operating rooms.

The Hemosafes are located in the OR on SZT 3, 4, & 5 and in the Weinberg OR and distribute both crossmatched and Emergency Release blood.

Bowman is ready at the Blood Bank window to provide Blood Products

Our new Walk-In Refrigerator was the most exciting addition to our new lab space as it provides space that we previously had to use six other refrigerators for.

Mary Goble-Lee is diligently reviewing RBC antibody cases in the Reference Lab

Our new Conference Room in Transfusion Medicine provides a space for Continuing Education and Meetings.

A new bulletin board just for Continuing Education is now in our new Transfusion Medicine Lab.

Transfusion Medicine Breakroom

We have two plasma defrosters (left) in the Lab to aid us in our Massive Transfusion Protocol, along with four plasma thawers (right) that are the workhorses for thawing plasma for our Plasmapheresis patients.

The new TM Lab has been an exciting change for the staff.  The staff now has a new and clean space to work and make their own, and the opportunity to modify workflow in to make the new lab the most efficient work space possible.

Cytopathology

The opening of the Zayed Tower created some logistical challenges for the Division of Cytopathology which partially moved to the new building.   Both the pathologist-attended FNA Ultrasound Service, as well as the cytotechnologist-attended Endoscopy Service, are housed in a spacious room adjacent to the Endoscopy Suite on the main level of Zayed.

Cytotechnologists Anna Novak (l) and Susan Otell (r) in new Cytology room in Zayed. In the center is the multi-headed microscope our pathologists use to review cases for sign-out.

Anna Novak analyzes a cytology specimen

Although it has been a challenge to transport fine-needle aspirations procured in Zayed to Path 4  and return the processed specimens to Zayed for screening and release, the staff working in the new building very much enjoy their new work space.  Assuring accuracy and efficiency of service by coordinating FNAs, cell blocks, core biopsies and their attendant special stains continues to be our top priority.

#     #     #

Special thanks to Chris Hostetter and Core Lab leadership, Melissa Neally of Transfusion Medicine, Fran Burroughs, Susan Otell and Anna Novak of Cytopathology, and Mike Huppenthal for their contributions to this posting.

The Core Lab overnight shift put together about 125 bags which went directly to the units last Friday for the sick kids unable to trick or treat.  From the day shift’s faculty, fellows and staff, there were kid-size items that included finger puppets, beaded necklaces, and small lollipops (a mega hit), that were part of the treat table.  There were 90 bags from Transfusion Medicine and Microbiology stuffed with Matchbox cars, coloring books, Webkinz, jigsaw puzzles, bubble blowguns, Rubik cubes, colored pencils and crayons, fairy wings, stuffed animals, M & M candies, and finger puppets.  Surgical Pathology collected a great amount of toys and other fun play items which were a huge hit, as well!   There were lots of trick-or-treat bags filled with assortment of things geared for teenagers, and you could just see how thrilled they were!  There were bandanas, puzzles, glow bracelets, journals, jewelry, Rubik cubes, Sudoku, crossword puzzle books, and notepads.

One could see how tired the kids were until they fully embraced the idea that there was a special toy there waiting just for them, including the Minnie Mouse coloring books for the little girl dressed up as Minnie Mouse, the Avenger puzzle for the 6-year-old boy dressed up as Captain America, and the fairy wings for the 4-year-old girl dressed as Tinkerbell!   Many of the girls were able to pick something out in their favorite color from the disco ball necklaces, large skate key rings, bandannas, pencils, finger puppets, or light-up finger rings, and more.  The boys were thrilled with the stretchy lizards, mini-deck of cards, and the shark tooth necklaces.

Everyone who made a contribution brought something special to these kids!   There are too many people to name who played a part in the Halloween festivities – there were so many donations from so many people across Pathology.

Special kudos to Lorraine Blagg, Theresa Cantone, Jean Lavelle, Paula Mister,  Karen Wittler, Maisha Cron, Georgina Pillainayagam, and Gay Vergara who so generously  gave of themselves to help create a Happy Halloween for the kids.

May we continue to bring cheer and Halloween fun to our very special young patients in the years to come!!

Our Microbiology and HIV Laboratory Lab presented information on sexually transmitted diseases (STD).    Paula Mister and Estelle Piwowar-Manning gave brief PowerPoint talks on HIV/AIDS and other STD, including syphilis, gonorrhea, chlamydia, and herpes.   Students participated in a mock epidemiology experiment in which they exchanged “bodily fluids” using tubes of water.  Two of the tubes were randomly “infected,” each with a different organism not visible in the tubes.  Samples from the tubes were then plated on agar media, and the next day students were able to see who had gotten “infected” and how the two “diseases” spread through the population by observing what grew on the plates.  The fact that an “infected” person was not visible (i.e., symptomatic) at the beginning, and the fact that two diseases can be present in the same individual, simulated actual STD transmission.   Students were asked to use critical thinking skills to come up with new ideas about how to stop the spread of these diseases and encourage faster diagnosis and treatment.   Most ideas focused on better education and communication, especially in their own adolescent community.

The Transfusion Medicine Lab presented information regarding Blood and Organ Donation.   Lorraine Blagg provided two brief PowerPoint presentations titled “Bankrupt Blood Banks” and “Liver Transplantation” to emphasize the importance of blood and organ donors. The students participated in a mock blood drive with the assistance of Rebecca Perry. The students were each given photo identification and given turns as both the blood donor and as a member of the blood drive. They performed the donor history questionnaire interview, took vital signs, cleansed the donor arm, and provided post-donation care with cookies. The students were asked to use critical thinking to recruit and evaluate blood and organ donors and identify transportation options for blood products and organ transplantation.   The overarching theme was the importance of community support to assist local hospitals through blood and organ donations.

Donor blood pressure check

Donor phlebotomy

Donor’s post-donation snack

“Lipids and Livers” were the hot topics presented by Core Lab.   In the Lipid session our college senior volunteer, Keisha Davis, and our brand new Chemistry fellow, Dr. Athena Kantartzis, presented the “problem” of high lipids in patients.   The students were challenged to figure out two ways to educate the public about good habits to keep lipids low and prevent health problems.   In the hands-on Lab portion, the students preformed a spot test looking for high lipids on “pretend” patients.  On the final day of the program, the students created their own version of this Lab test and later taught the Dunbar 9^th graders to perform their first diagnostic test.

During the Liver session the students reviewed anatomy and liver function. They learned about the clinical outcomes of an unhealthy liver.   We focused on non-genetic liver disease and brainstormed how these can be prevented in order to have better quality of life and lowered healthcare costs.   In the interactive module, the students “rounded” to four patients. They read each patient’s history and symptoms and interpreted a colorimetric version of a liver function test.  They then collaborated with one another and diagnosed the liver disease and suggested next steps for the patient.

Throughout the four-week Young Scientists in Training program which included parallel sessions in Diagnostic Radiology led by Charrise Lomax, the favorite questions were “How?” and “Why?”   For each question asked and answered, there was another question to go deeper and wider — to really think through the answer and the possible actions.   Students could see that this is not an easy process in medicine and that the first line action may cause new questions or consequences.   Hopefully, the 2012 sessions this summer taught good laboratory medicine, as well as, the life skill of critical thinking.

We enjoyed working with the students on this special project and welcome any interested employees to participate in future endeavors with our Dunbar youth.

Johns Hopkins Pathology Education and Development Coordinators
Paula Mister, MA, MT(ASCP),  Microbiology Division
Lorraine Blagg, MA, MLS(ASCP)^CMSBB, Transfusion Medicine
Christine Hostetter, MA, MT(ASCP), Core Laboratories

At the end of 2011 a new committee – the JHMI Continuing Laboratory Medicine Education Committee – was commissioned to standardize, streamline, and share continuing education opportunities/information for Laboratory staff across the Health System.   Committee members represent laboratories across Johns Hopkins Hospital, Bayview Medical Center, Howard County General Hospital, Suburban Hospital, and Sibley Memorial Hospital, as well as staff who have a strong interest or responsibility in continuing education activities.

The first task of our committee was to determine what the Pathology laboratory employees of Johns Hopkins Medical Institutions (JHMI) needed and wanted in regard to continuing education.   So a continuing education survey was distributed via Survey Monkey to JHMI Pathology staff in January 2012.

The participants:   Over 25% of Pathology laboratory employees participated in the survey with participation from all sites, all position types, all shifts, and both certified and noncertified employees. Refer to the participant pie charts below for specific percentages of the demographic categories.

The Results:   The survey looked at what participants perceived were the limitations in continuing education and what types of activities they would like to have available to them and at what times.   The survey identified the main issues that could impact one’s ability to participate in continuing education activities.  The top issues were:   available time, expense, and accessibility, with lab coverage and topic content close behind.

The continuing education preferences seem to indicate that most would participate in any type of CE activity if made available.  The time preference was more scattered across multiple days and times.

Additional comments were made to provide more continuing educational opportunities for all staff regardless of their location, position, or shift, and to have continuing education requirements for all JHMI Pathology employees.

The JHMI Continuing Laboratory Medicine Education Committee has been working diligently to make, prioritize, and accomplish objectives determined from the survey.  So far, the committee has made recommendations to standardize minimal continuing education annual requirements for laboratory staff across the Health System.  The Pathology Continuing Education Policy is now located on Hopkins Policies Online (HPO); the link below can be accessed by internal users with a JHED ID:

http://www.insidehopkinsmedicine.org/hpo/index.cfm?event=ManualSections.List&mid=68

Additionally, the committee has been working to provide a way to share and notify employees of continuing education resources and opportunities that are currently available and working towards providing more continuing educational opportunities that will be available to all staff regardless of physical location, position type, or shift.

Below is a list of free Continuing Education Resources:

1.   Abbott Point-of-Care http://www.clinicaledonline.com/pointofcare/

2.  Advance for Medical Laboratory Professionals http://laboratorian.advanceweb.com/

3.  American Red Cross SUCCESS (need customer code) http://success.redcross.org/

4.  BioConference Live   http://www.bioconferencelive.com/

5.  Blood CME Center http://www.bloodcmecenter.org/Default.aspx

6.  Laboratory Medicine Best Practices https://www.futurelabmedicine.org/default.aspx

7.  Quest Diagnostics http://education.questdiagnostics.com/

8.  Radiometer Webinars http://www.radiometeramerica.com/en-us/services/radiometer-university

9.  Roche NimbleGen http://www.nimblegen.com/support/index.html

10.  Sysmex https://www.sysmex.com/us/en/Education/Webinars/Pages/Webinars.aspx

11.  MyLearning at Johns Hopkins Medicine (need JHED ID) http://www.hopkinsmedicine.org/interactive_learning/my_learning/ Microsoft Office Training Modules (Skillsoft)

If you have any questions, comments, or suggestions about continuing education or about the committee, please feel free to contact us.  We welcome your continued feedback.

Continuing Education Committee Members:

Barbara Detrick, Ph.D.
Professor of Pathology
Director, Immunology and Cytokine Laboratories

Barbara Parsons, MA, MT(ASCP)
Assistant Director, Quality Management, JHU

Christine Hostetter, MA, MT(ASCP)Education and Development Coordinator
Education and Development Coordinator, JHH Core Lab

Cynthia Jordan, MT(ASCP)
Performance Improvement Specialist, Pathology, Sibley Memorial Hospital

Debbie Williams, BA, MT(ASCP)
Coordinator, Laboratory Quality Assurance, Suburban Hospital

Doris Pendergrass, SPHR
Human Resources Manager, Department of Pathology

Eun Hee (Annie) Cho, MT(ASCP)
Laboratory Specialist, JHH Immunology Lab

Fran Burroghs, SCT(ASCP)IAC
Supervisor, Cytopathology Technical Operations

Jo Shim, MBA, MT(ASCP)
International Lab QA/QC Coordinator, JHU

Katina Williams, H(ASCP)
Education & Development Coordinator, JHH Surgical Pathology Lab

Lorraine Blagg, MA, MLS(ASCP)^CMSBB
Education & Development Coordinator, JHH Transfusion Medicine Lab

Marian Turpin
Continuous Quality Improvement Office

Paula Mister, MS, MT(ASCP),SM^CM
Education & Development Coordinator, JHH Microbiology Lab

Rosemary Hines, MBA, DLM(ASCP)
Director of Finance, Johns Hopkins Department of Pathology

Suzy Nicol, MS, MT(ASCP)SBB
Laboratory Manager, John Hopkins Bayview Medical Center

Tammy Heacock, MT(ASCP)
Laboratory Specialist, Training, Competency, & Continuing Education, Howard County General Hospital

Terry Aman
Medical Training Program Manager, JHU School of Medicine

Milagros Perez, Alissa Arellano, and Heather Smith after receiving their certificates

Milagros Perez accepting her certificate

Sashika Krisnaratne, Alissa Arellano, and Wei Cai

Sue Fiorino, Joan Boyd, Heather Smith, Karen King, and Dr. Patricia Brunker

Each student has chosen to write about their experience over the past year in the program.

Alissa Arellano, MT(ASCP), wrote:   “After completing the SBB program at The Johns Hopkins Hospital, I am left with overwhelming feelings of accomplishment and gratitude. The most interesting part of my experience was having the opportunity to meet many different pathology physicians on a daily basis.  Through these interactions I was able understand how critical laboratory processes affect the care of patients requiring blood transfusions and/or other cellular therapies.  My overall experience has helped me prepare for a very rewarding career in Transfusion Medicine.”

Milagros Perez wrote of her experience over the past year and her future plans:  “I am very excited to have completed the year!!   It has been a very difficult one but it has been extremely rewarding as well!!    The most difficult part for me was the fact that many friends and family members could not quite understand that you have no time for them.  Every weekend and any free time I had was dedicated to school.  So that was hard but eventually everyone understood what I was going through. 

I really enjoyed going to the NIH and AABB conferences — meeting the other SBB students and hearing their stories. The Red Cross experience was excellent; they made us feel so special.  The same happened with the other rotations :  HATS, platelet transfusion coordinators, HLA labs, FDA, Cellular Therapy Lab, and the others.    I learned so much from them.  Our own Blood Bank rotations were very helpful; all techs involved made sure the checklists were covered.

After such a long year, I am planning to “sit” in my house in Venezuela and spend some time in Florida. I will be looking for a job in the Middle East.  Hopefully, I will be able to get a job in which my SBB knowledge will be needed.  There are two new hospitals opening in Doha, Qatar and Dubai, United Arab Emirates.  My hope is to get a job in either place.   There is also Riyadh, Saudi Arabia, my former job, which has already contacted me, so I am thankful for that.

Thanks to everyone for all the help and dedication!!”

Heather Smith wrote:  “After completing the Specialist in Blood Banking program at Hopkins, I felt more than prepared for the ASCP SBB exam and shortly after graduating, I sat for the exam and passed.  The structure of the program here at Hopkins incorporates formal lectures, work experience, and the opportunity to visit various sites such as the Red Cross and the FDA to help learn the information needed.  The combination of the different ways in which the information was presented helped me to understand and retain the information a lot better than if I would have just learned it from a book. I highly recommend this program to anyone interested in becoming an SBB. “

Our New SBB class: Keerthana Ravindran, Rebecca Perry, and Felix Medrano

Our incoming students, Felix Medrano, Rebecca Perry, and Keerthana Ravindran, were able to participate in the graduation festivities to prepare them for the year ahead.  They started the program on September 10, 2012.  Each brings with them experiences that ultimately led them to our SBB program.

Felix Medrano came to The Johns Hopkins Hospital after two years experience at Saint Joseph’s Regional Medical Center in Paterson, New Jersey.   He completed his B.S. degree in Biology at Ramapo College of New Jersey, and his clinical training at The Valley Hospital in Ridgewood, New Jersey.    Educational advancement is one of his main priorities in life.   He stated, “SBB certification is basically a Masters degree in Blood Bank.  Completing my training at Johns Hopkins is a worthy challenge and a dream come true.” 

Rebecca Perry is from Duke Hospital where she gained nine years of blood banking experience.  Rebecca came to The Johns Hopkins Hospital for SBB School to experience how another large facility works, hone her blood banking skills, and obtain the educational foundation to begin a career in laboratory management.

Keerthana Ravindran wrotes:  “While working at Mountain View Hospital in Las Vegas, Nevada, I was fortunate to have become involved in a CAP inspection for Transfusion Medicine, validation and training for the automated instrumentation ECHO, and developing policies as well as monitoring quality indicators.  These experiences have been essential in fortifying my passion for the field of Transfusion Medicine and ultimately in the decision to obtain a specialization in blood banking. After completion of the program, I plan to use excellent communication and management skills, in addition to critical thinking in order to obtain my CQA and work as a quality specialist while providing the best possible patient care.”

Some of the Blood Bank staff celebrating with our SBB graduates

We are very proud of our recent graduates and are looking forward to another excellent year with our new class!

Lorraine Blagg, MA, MLS(ASCP)SBB
Education and Development Coordinator
Transfusion Medicine Division
The Johns Hopkins Hospital

PRIOR TO GO-LIVE

We are just a few days before go-live. Everyone in the respective labs has been trained, instruments have been validated, and we’re waiting for 8/11/2012.

Remember  . . .  you need to log-on to the Citrix icon with your JHED ID and password (what you use to access Outlook email or your Payroll info on-line).  You then log-on to the appropriate Soft module within the Citrix desktop using your Soft ID and password.

During the days prior to go-live (8/6-10), you will also be able to access the Soft Test environments to continue to practice with the system if necessary.

AT GO-LIVE

In an effort to fully support the Go-Live, members of PDS, the Soft build team, and vendor representatives will be on site 24/7 from 9:00 a.m. Saturday, 8/11, through Friday, 8/17, and longer, if needed.

Staffing will be staggered with at least two members on the Soft build team and PDS personnel on-site at all hours during the first week of Go-Live, with the Soft build team floating through the labs to assist  with instrument switching, password resets, and any Soft-related questions/issues through the first few days.

Support staff for the Soft Go-Live will be located in Meyer B-105 (General Work Room with vendor support), Meyer B-121 (Quiet Room for answering phones), and Meyer B-130 (Troubleshooting Room).

The following is a list of events that will occur on 8/11 that all lab personnel need to be aware of:

8/11 (Saturday)

• 9:00 a.m. – PDS Downtime for necessary Soft-related changes
• 10:00 a.m.  – PDS comes back on-line
• 12:00 noon – Soft comes on-line

8/13 (Monday)

• 7:00 a.m. – All Outreach sites will come on-line

After 12:00 noon on 8/11, when Soft is Live, if you have an issue and cannot locate a Lab Super User or a Build Team Member, you should call one of these three numbers:

          Ext. 7-4296   (443-287-4296)

          Ext. 7-4300   (443-287-4300)

     Or Ext. 5-HELP (Ext. 5-4357) in the event you cannot get through to either 7-4296 or 7-4300.

Either of the first two numbers will connect you to Meyer B-121 where someone there will take your information.    When calling, you should be prepared with the following information:

1. Your name, JHED ID, and Soft ID.
2. Problem Type – Instrument Issue, Printer, Access to (Citrix or Soft).
3. Soft Module you are trying to access.
4. Patient Information, if applicable – Medical Record, Order Number, Tests, etc.
5. A brief description of the problem.

AFTER GO-LIVE

Throughout the 24/7 support process, the Support team will be monitoring the system, the trouble tickets and any issues.   At some point — probably after 7-10 days, a determination will be made to move to a standard on-call support module.

Once a decision is made, communication will go out from the Department that 24/7 support on-site will be shut down at a specified time.   Going forward, any Soft-related issues or problems will be called to the Hopkins Help Desk at 5-HELP (ext. 5-4357). PDS will continue to maintain its current support module utilizing ext. 5-2656 for all PDS issues or problems.

What this means:   If you are a lab utilizing the Soft system and you have a problem with Soft, you’ll call 5-HELP (ext. 5-4357).  If you are a lab utilizing PDS and you encounter a problem, you’ll call 5-2656.

Gregory Rex
Soft Applications Project Leader
Department of Pathology
Johns Hopkins Hospital
grex1@jhmi.edu

Front row: Briana McDuffie and Nichola Mathews. Back row: Damara Nesmith, Autum Morton, Myesha Oliver, Khadijah Williams, Sabrina Christian, Da’Rae Solomon, and Brittany Phillips

Once again, the JHH Department of Pathology is participating in the Johns Hopkins Summer Jobs Program which provides Baltimore City students the opportunity to complete a six-week paid internship in one of various departments throughout the Institution.   The Summer Jobs Program is in its 16th year under the guidance of the current Director of Project REACH/Community Education Programs. This program provides student interns with exposure to workplace culture and potential career paths in an educational setting. It also promotes mentoring and fosters personal responsibility. Through exposure to Pathology, we hope to inspire youths to pursue laboratory careers.

The 2012 summer program kicked off on Monday, June 18, and will run through Friday, July 27.  A total of nine summer interns are working within Core Lab, Microbiology, Transfusion Medicine, and the CQI Office.

One student intern has been donning gloves and a white lab coat in the new Core Laboratory, receiving specimens at the drop-off window and the pneumatic tube station. She is learning the important steps that are taken prior to the testing of patient specimens.

Brittany Phillips

Eight student interns are involved in a document control quality improvement project that was developed after the CAP inspection in September 2011. We set a goal to transfer our laboratory procedures to a Web-based application called Hopkins Policies Online (HPO) before the next inspection in 2013.   HPO was created by the Institution to provide a central depository for managing hospital policies, procedures and other documents.  Documents are electronically created, maintained, tracked and managed.  They are published on the Johns Hopkins Intranet website for easy access by the end-users.  By using HPO for document management, Pathology will have standardized procedures that are regulatory-compliant.

Four of our interns: Autum, Myesha, Khadijah, Sabrina

The summer interns have been working on the HPO project since their first day here. They received HPO training on the first day and have worked steadily to move existing policies/procedures into specific online technical manuals. Once the policies/procedures have been loaded on to HPO, each laboratory division can start to review, edit, and publish them.  Many of our supervisors, leads and managers have been involved in mentoring the students and monitoring the progress of the project.  Halfway through the project, over 500 procedures and policies had been transferred by the summer interns to HPO!

Nichola Mathews

In between all the copying, pasting, and typing on computer workstations, the Department has also provided the summer interns with activities that expose them to other areas of the laboratory and Hospital.   Natalie Wallace gave tours within Pathology and the new Clinical Towers. Juanita Stem provided insight into laboratory quality and regulatory processes with an afternoon lecture.  Karen Reilly took the interns into some clinical areas where Point of Care testing audits were being performed.  Barbara Parsons showed the students an archived webinar, Building Communication Skills.

Our interns shared their thoughts about their summer experience at Johns Hopkins and in Pathology:

“While working on the HPO project I learned more about the Hospital computer system.  The internship gave me hospital experience.  I learned that Pathology has many different areas that all have great value to the hospital. I also learned that Johns Hopkins is very serious about their policies and procedures.“  Damara Nesmith, 15, Paul Laurence Dunbar High School

“One of the new skills I have acquired while working on the HPO project is how to transfer different files, and I learned there is an easier way to use the web site.  The summer internship has met my goals by helping me to broaden my horizons. I also learned the Department of Pathology is where you study human disease and that there are many different laboratory areas within Pathology.  Another thing I learned about Johns Hopkins Hospital is that there are people who really appreciate helping others and really enjoy their jobs!“  Briana McDuffie, 12^th grade, Friendship Academy Engineering Technology

“While working on the HPO project, I learned how to identify different sections of Hospital policies, and that the various policies that I helped to publish are viewed daily by employees in the Johns Hopkins Health System.  Additionally, I learned that the Department of Pathology is one of the largest departments in the Johns Hopkins Hospital and almost 80% of diagnoses for patients come from laboratory testing.”  Myesha Oliver, 18, Salem College

“Working at Johns Hopkins this summer has been a great experience for me. Being in the lab has taught me the important value of teamwork. Although everyone in the lab works separately on their own tasks, the entire process of processing, testing, and sending specimens could not be done efficiently without everyone’s hard work. I will use what I’ve learned this summer in my day to day life, as well as write my senior speech on my experiences in the Pathology lab!“  Brittany Phillips, 16, Saint Paul School for Girls

“During my time working at Johns Hopkins, I’ve learned how to better myself by typing on the computer and learning proper writing techniques. Working with Pathology, I’ve come to the conclusion that you need many charts and formulas in order to do a proper procedure. Working in the Hospital, I noticed that for every section of work, you have to wear a different color scrub.  I also saw in the Children’s Hospital the sculptures that resemble animals.” Autum Morton, 15, Milford Mill Academy

“Working at the Johns Hopkins Hospital has been an excellent learning experience.  I have learned how to work with people both like myself and different from me. This program has also increased my communication skills within a working environment. I have learned to participate in meetings, send proper emails and use other skills to help communicate amongst my co-workers. After working at Johns Hopkins, I have gained the confidence to work in any environment.” Sabrina Christian, 16, Western High School

“I learned how to do procedures and policies on HPO and how to fix formats.  I learned that the Pathology Department studies human diseases. I took a tour of the new Hospital and I learned what every scrub color meant.”  Da’Rae Solomon, 18, Stevenson University

“As a student who has been participating in the JHU summer internship since sophomore year, I know just how special this experience can be. Every year, I get to meet new people, learn more things and explore the hospital campus. This year working in the Pathology Department, I improved my organizational skills and gained more focused work habits. I look forward to learning more from Johns Hopkins when I return next year!”  Nichola Mathews, 17, The Catholic High School of Baltimore

“Working in the Pathology Department has been an incredible experience. I never knew that all of these interesting jobs were in this department. I would love to work in the pathology field, and this summer has strengthened my interest.”  Khadijah Williams, 16, Baltimore City College

Thanks to the summer interns for their contributions to the Department of Pathology!

Thanks to all the Pathology mentors for their support of this program!

Barbara Parsons
CQI Office
Department of Pathology

Shirley Myers Manager with her Pathology Billing team

At 9910 Franklin Square Drive in White Marsh, there are 32 busy Pathology employees performing the duties of medical billing for the Department of Pathology. Whether working on a patient’s registration problem, posting a payment, updating an insurance claim, following-up with the insurance company for payment, or making sure we send a clean claim out the door according to the policies of the Johns Hopkins Clinical Practice Association and the billing rules for Medicare (CMS), our goal is to perform these tasks efficiently and effectively.

Our team is made up of a manager, an assistant manager, two supervisors, ten collection specialists, two company account collection specialists, four payment posters, nine billing coordinators, a charge entry specialist, a claims specialist, and a patient quality assurance specialist.

Although there are multiple small groups who do billing for various divisions such as the Johns Hopkins Medical Laboratories, the Green Spring Station Laboratory, the Johns Hopkins University Reference Laboratories, and Professional Fee Billing, we all work together to maximize the revenue for the Department of Pathology.

Among our other duties, we also bill for other Departments such as the IVF Laboratory at Green Spring, the Genetics DNA Laboratory, and Dermatopathology.

Shirley Myers
Manager, Professional Fee Billing Office
Department of Pathology

As part of its commitment to continuing education,  the Department of Pathology sent nearly 300 employees from Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, and Sibley Memorial Hospital to the annual ASCP Workshops for Laboratory Professionals in Towson, Maryland, between May 1-4, 2012.  Some of our employees shared their reviews with us, and we are thankful for their generous time:   

Practical Hemostasis: Laboratory Aspects of Bleeding and Thrombosis

The presentation, Practical Hemostasis:  Laboratory Aspects of Bleeding and Thrombosis, was very interesting.   It covered coagulation factors such as intrinsic and extrinsic factors and the disorders associated with each.  One interesting topic was the determination of factor deficiency vs. factor inhibition, whereas factor deficiency corrects with mixing study, factor inhibition would not.   Our bodies’ ability to regulate/increase the level of Factor VIII during trauma situations would lessen the degree of bleeding.  However, postpartum patients have high risk of bleeding.   Despite the fact that they are going through a trauma situation, estrogen and progesterone interfere to inhibit Factor VIII which explains the high risk of bleeding.

Towards the end of the presentation, the importance of correct sample collection, including the serum-to-anticoagulant ratio, was discussed.  Abnormal results that are not consistent with patient results should be further investigated.

Overall, the presenter was very knowledgeable and I found it very interesting.

Yeshanew Teklie, MT(ASCP)
Clinical Laboratory Scientist III
Howard County General Hospital

I attended the workshop entitled “Practical Hemostasis:  Laboratory Aspects of Bleeding and Thrombosis.”  This workshop was very informative. Both presenters were very clear and knowledgeable about the material.  They went over the intrinsic and extrinsic pathways of the coagulation cascade, which was a nice review.   The details of Factor assays is not something I think about when running routine coagulation tests, but our presenters talked about how different factors affect the PT/PTT/TT and Fib results.   The last part of the workshop dealt with anticoagulant therapy and the effects these drugs have on the PT/INR and PTT results.  This we deal with on a daily basis.

Both presenters were open to questions, often referring to each other for clarification of the answers.

Roselyn Caslin, MT(ASCP)
Clinical Laboratory Scientist III
Johns Hopkins Hospital

The workshop “Practical Hemostasis: Laboratory Aspects of Bleeding and Thrombosis” was very informative and provided in-depth review on hemostasis.  It covered both coagulation and fibrinolysis systems and tests for evaluation of bleeding and clotting disorders. The speakers,  Dorothy M. Adcock-Funk, M.D., and J. Michael Taylor, M.S., gave a brief review on activated partial thromboplastin time and prothrombin time assays and how to evaluate abnormal results.  They also discussed the focus on cost-effectiveness; how to monitor anticoagulant therapy and how newer anticoagulants interfere with hemostasis assay.  Overall, this workshop really helped me understand the laboratory aspects of hemostasis.  I highly recommend this workshop to anyone who wants to learn more about hemostasis.

Farhan Ahmad
Clinical Laboratory Scientist II
Flow Cytometry Laboratory
The Johns Hopkins Hospital

The Art of Phlebotomy

The Art of Phlebotomy workshop, given by Marilyn Singleton McCain, was very informative.  Although I have been drawing blood for over 20 years, there was so much new material presented that will help me to improve my phlebotomy knowledge and skills.  We learned about the latest OSHA, CLSI, and NAACLS regulations and guidelines regarding patient and personal safety when performing phlebotomy and about the newest safety devices, as well as bloodborne pathogens, legal and risk management updates, how to improve customer service and communication, and how to improve venipuntures.  As an example, I learned that a certain place on the inner arm has many nerves which will become damaged if a patient is stuck there multiple times over a course of years, and so that is it important to avoid that area.

To summarize, I believe this was an excellent workshop and I highly recommend it to other phlebotomists or those who perform phlebotomy on a regular basis.  Ms. Singleton McCain was a dynamic speaker who taught me a great deal.

Sherrie Hicks-Rose
Certified Phlebotomist/Lab Technician
Core Laboratory
Johns Hopkins Hospital

The ASCP’s “Art of Phlebotomy Workshop” was very interesting and helpful, particularly the time devoted to documentation. Our presenter, Marilyn Singleton McCain, stressed how important proper documentation is in the phlebotomy field. Documentation is used as a tool to help determine answers to specific questions about a patient’s blood draw. Certain guidelines must be followed when documenting. Always documenting in ink insures that information cannot be changed or erased. Recording a patient’s name insures correct patient identity. Recording date and time of each collection fortifies the collection of all specimens. Using medical terminology is a concise method which helps to avoid any confusion for written narratives or lingo. Drawing a line through mistakes with initials allows us to visibly see a mistake without appearing as a cover up. Documenting all adverse occurrences is important, e.g., patient refused blood draw, difficult draw, patient experienced syncope, etc. Documentation can be legally binding and, therefore, you should never document or sign-off for anyone else.

These few but very important steps give clear, concise, and legal information that answers questions to any additional issues concerning a patient.

Lennoria Joseph
Laboratory Phlebotomist
Johns Hopkins Bayview Medical Center

Passing Inspections:  Practical Game Plans and Proven Strategies
       and
Improving Quality:  QC is More than Statistics!

Passing Inspections:  Practical Game Plans and Proven Strategies

Looking ahead to non-waived testing, EQC (Electronic Quality Control) will be replaced by EP23 in 2-4 years, by 2016 at the latest.   EQC refers to the manufacturer’s approach to QC — electronic, procedural, built-in liquid that differs from CLIA Gold Standard External Liquid QC.   EP23 refers to hospital-based lab evaluation protocols that we establish.  Competency is an especially hot item this year. A more detailed and creative measure of each employee’s skills is required. Some of you may have already experienced this in preparation for your upcoming evaluation. This competency revision includes: direct observation of patient testing from the beginning of the test protocol, entering the final result, answering questions asked by the lead involving problem solving, observing instrument maintenance performance and troubleshooting skills.   There is nothing new on the horizon for waived testing other than following the manufacturer’s directions.   We rarely, if ever, get loaner instruments.  However, if we do, we need to treat them like a new instrument. That means you must establish QC for any loaner instrument.

Improving Quality: QC is More than Statistics!

This QC workshop was elaborate in covering the many factors involved in defining good QC.  I will briefly discuss several of topics that I can relate to in my work.  Patient safety is one of them and it can be enhanced through Quality — meaning right vs. wrong.  Risk management is necessary to ensure quality through all phases of the patient testing process.

As professionals, we can all play a role throughout this process beginning with the preanalytical phase and ending with the post analytical phase.  We can catch potential errors prior to them becoming risks that affect patient safety. Risk management and QC are essential for Analytical Quality (Regulations, Proficiency Testing, Six Sigma, CAP Inspection, etc.).  For more information about patient safety, AACC offers a free monthly newsletter on patient safety at www.aacc.org.

It is also helpful to know what Jim Westgard’s rules really mean as they relate to QC. It is more than statistics. It is about random error vs. systematic error. This matters in how you would respond to correcting the error. For example, R4s rule is a random error. In this case you would rerun the sample.  This could be caused by bubbles in reagents and reagent lines, testing personnel variation, or other things.  In contrast, 41s rule is a systematic error. Repeating the sample or opening a new vial is not the solution. Further investigation is required due to an internal cause, e.g., pipettor misalignment, reagent issues, change of lot numbers, and other causes.  For more information, there is a free website, but you must register, www.westgard.com  and click-on Multirule Interpretation.

Bette Ford, MLT (ASCP)
Lead Clinical Laboratory Scientist
Hematology Laboratory
Johns Hopkins Hospital

Improving Quality: QC is More Than Statistics!

Each Spring I anxiously wait for the ASCP Workshops flyer to arrive. I know that in addition to the valuable technical knowledge available, there is another less tangible benefit: that sense of refreshment and renewal that comes from gathering with the wider community of colleagues to look at new topics and not-so-new topics from a new or different perspective. Sometimes there is validation for our current stance or practice; sometimes there is a way to fine-tune something we are doing. Sometimes there is a new way to relook at something we have been doing for a long time.

For me, there was a little of each of those in the “Improving Quality: QC is More Than Statistics!” session. Sharon Ehrmeyer, who heads the MT/CLS program at the University of Wisconsin, is a vibrant and enthusiastic speaker with a lively sense of humor. In a session which seemed far shorter than the clock on the wall showed, Dr. Ehrmeyer reminded us of just why Quality is spelled with a capital Q for laboratorians, how intimately the quality of our laboratory testing is related to patient safety, and just how useful the term “risk” is in thinking about our whole testing design. As Dr. Ehrmeyer stated, “Realize, we are always involved in Risk Management!”

Moving from the ethical and theoretical bases to the legalities, we reviewed the CLIA regulations, highlighting those with more specific statements and requirements for quality control, in particular, the so-called “Gold Standard” of two levels of QC at least once each day for patient testing. The CLIA definition of EQC opened a portion of the presentation devoted to the evolving nature and role of EQC (not electronic but equivalent QC), evaluation strategies, and shortcomings of EQC, and the interrelation of risk management, EQC, more traditional QC schemes and the Quality Control Plans which are a part of CLSI EP23.

No QC presentation would be complete without a review of the Westgard Rules, including a discussion of types of errors, and appropriate selection of the rules to monitor different types of error. However, Dr. Ehrmeyer went beyond a simple review into some depth with respect to selecting and implementing the right QC, using a formalized QC selection process, and using additional tools such as the OPSpecs Chart and Six Sigma Metrics to develop the right QC for each test.

The final slide of the presentation gave a very neat summarization of the huge amount and range of information covered, in five simple statements:

1. DO define quality required for each test.
2. DO select QC procedures to minimize false rejections.
3. DO select QC procedures to detect medically important errors for each test method.
4. DO adopt modern QC planning tools.
5. DO standardize QC operations. (www.westgard.com)

A whole session of QC could seem like a fearfully dry, humorless session, but the morning with Dr. Ehrmeyer was anything but dull, definitely not humorless, and worth every minute spent there. I am so glad I was able to attend.

Edith Burns, MT(ASCP)
Clinical Laboratory Scientist III
Point-of-Care Testing
Johns Hopkins Bayview Medical Center

It was a great privilege to attend the two half-day workshops presented by Sharon Ehrmeyer, Ph.D. on May 1.  Both workshops touched on CLSI’s new EP23, Laboratory Quality Control Based on Risk Management, and the relationship between quality laboratory testing, CLIA regulations, and CAP and Joint Commission standards.

Improving Quality:  QC is More Than Statistics!

During the morning session Dr. Ehrmeyer stressed how to make good choices to find the best QC material and process for each particular laboratory test.  She introduced the topic by relating quality laboratory testing to The Joint Commission’s Patient Safety Goals and, therefore, to hospital Risk Management.   She then explained how to use Westgard’s analytical quality framework to develop the best QC process for each laboratory test.

She also clarified how the concept of Equivalent QC fits into this quality framework from both CLIA and CAP perspectives.  She then demonstrated QC rule selection using Westgard OPSpecs charting (OPSpecs is Operational Process Specifications).  Dr. Ehrmeyer proceeded to show how the Six Sigma process can also be presented using the Westgard QC rules and the OPSpecs QC selection tool.  Finally, she did a review, using Risk Management to help choose the correct QC for the method

Passing Inspections: Practical Game Plans and Proven Strategies

The afternoon session stressed approaches to attain all the CAP or Joint Commission laboratory accreditation standards and how to prepare for an inspection, especially by performing self-inspections. Dr. Ehrmeyer explain in great detail the relationships between CLIA regulations and The Joint Commission and CAP standards, the deemed status, and the rationale behind CLIA regulations and CAP standards.  She had detailed hints directly from CMS Director of the Division of Laboratories, Judy Yost, on how to meet specific CLIA regulations.

Dr. Ehrmeyer’s talk also included a large section on Waived Testing and Point-of-Care Testing, including the definition of Equivalent QC (EQC) and how to demonstrate the equivalency of EQC.  She concluded her talk with a review of Competency Assessment and a reminder that we should continually strive for the Right Test, on the Right Patient, and the Right Specimen collected at the Right Time, with the Right “Handling” to give the Right Result, and deliver it to the Right Patient Record.

Judy A. Horton, DA, MS, MT(ASCP)
Laboratory Point-of-Care Coordinator
Suburban Hospital

The Chemistry “Markers” of Disease

I attended the ASCP workshop “The Chemistry Markers of Disease” on May 2nd.  The workshop was very informative, it was a good review of my prior knowledge and I learned about some testing that I have not personally performed before.  The instructor was very informative and kept the class interesting and engaging. The workshops in general are very organized and helpful.

Nicole Carroll, H(ASCP)
Clinical Laboratory Scientist III
Johns Hopkins Bayview Medical Center

The workshop, “The Chemistry Markers of Disease,” was presented by Lorraine Doucette, MLS (ASCP).   Ms. Doucette spent the morning session describing the cardiac markers that are used to diagnose Coronary Artery Disease (CAD) and Congestive Heart Failure (CHF).  She explained the pathology of CAD, the role of cholesterol in plaque formation, and the effects of diet and exercise on coronary health.  Unfortunately, a large part of the talk was spent on the pathology of disease and even the social and political ramifications of healthcare management, rather than focusing on the laboratory medicine that might have been of more interest to the laboratorians in the audience. The second half of morning session focused on bone metabolism and disease and the chemistry markers used in following bone health.  Ms. Doucette also discussed the endocrine functions of the kidneys and described how various chemistry parameters are affected by different diseases of the kidneys.  She gave a brief overview of endocrine function, describing the protein hormones and the steroid hormones, as well as the regulation of hormone secretion and some diseases of the endocrine system. The afternoon session included a discussion of liver diseases and liver enzymes, followed by discussion on various types of cancer and the use of tumor markers for diagnosis and treatment.  She also covered various types of enzymes and hormones and their roles in various types of diseases, as well as a brief discussion of serum proteins and carcinoma-associated antigens.

The day-long presentation was a good review of basic physiology and general chemistry.  Much of the talk focused on the pathology of diseases and even treatment of the diseases.  Although it provided a good overview, most of the discussion was very basic.  I personally would have liked more detailed discussion of current trends in laboratory medicine and challenges faced in the chemistry lab.  I suspect that most experienced medical technologists, especially experienced chemists, and might find the information in this presentation too basic.  The slide set provides an excellent review of chemistry, however, and it will be useful in the future to use as a reference and as a teaching tool for students, new MTs, or techs that have been away from the chemistry lab for a long time.

Anne Sholander, MT(ASCP)
Sr. International QA/QC Coordinator
Dept. of Pathology, SMILE

Is it Reactive or Malignant? Enhancing Diagnostic Skills in Morphologic Hematology

Ms. Jill Smith’s presentation, “Is It Reactive or Malignant? Enhancing Diagnostic Skills in Morphologic Hematology” was both informative and thought-provoking.  The material covered many of the morphologic features that can aid in the diagnosis of a hematology or oncology patient.  In the Hematology Laboratory located within the main Core Laboratory, we routinely see “reactive” lymphocytes as well as malignant cells so this part of the presentation was basically an overview.

The pieces of the presentation that I found thought-provoking were other techniques that laboratories perform that we don’t necessarily carry out, such as scanning the feathered edge of the slide for an indication of what we may see in the smear.   In my opinion, this technique could go either way — it could help someone find any otherwise absent Microfilaria, as in Ms. Smith’s example, or it could confuse a less experienced technologist.  Another concept I was introduced to was the vortexing of specimens to get rid of platelet clumps.  Although I found this to be extreme, it was an enlightening piece of this lecture.

I also enjoyed the review of the many types of morphologic changes that one may see in particular disease states and malignancies.  Though we may differentiate these into much broader categories such as “prolymphocyte,” “blast,” or “young unidentified” cells, it was a great review of all the particular types of cells we often see.

What I like most about workshops such as these are discovering other techniques laboratories around the nation employ compared to what we do at Hopkins.   Sometimes we tend to forget that our way is not always the best way, or maybe we are reminded of why we do things the way we do.

Holly A. White, MT(ASCP)CM, MSHS
Clinical Laboratory Scientist III
Johns Hopkins Hospital
Research Program Assistant II
Johns Hopkins Bloomberg School of Public Health

I went to the Hematology session, “Is It Reactive or Malignant:  Enhancing Diagnostic Skills in Morphologic Hematology.”  The session was informative and the presenter was very knowledgeable.  In a session like this, you have plenty of examples to get a viewable understanding of the subject.  Jill Smith gave the 100+ attendees plenty to view and good explanations, as well as personal insights.  The subjects reinforced some of my personal knowledge and updated me on the newer methodologies of diagnostic hematology.   There are new molecular tests that can be used for such diseases as lymphomas and myeloid leukemias.   Always keep in mind, however, that a good tech can see new cases on a simple blood smear.  You may see blasts or megakaryocytes or that lymph that “just doesn’t look right.”  That’s when you KNOW you have made a difference.  That’s a discovery.

John T. Hargrove, MT(ASCP)
Coordinator of Client Services, Clinical Laboratories
Johns Hopkins Bayview Medical Laboratories
NPR Report Writer

Quality Management Systems – Transitioning for the Future

Ruth Biehl and Chloe Scott took us through the Quality System Essentials in relation to ISO 15189 Guidelines.  The presentation was a great review to be certain we are up to standards with our own Quality System.   A group exercise provided hands-on practice in applying the essential element concepts.  Ruth and Chloe had us work through the system essentials to teach a three-year-old child how to make a peanut butter and jelly sandwich.   We took each essential in order, beginning with Organization all went the way through Purchasing and Inventory.  It was a fun and functional exercise that required you use your understanding of each system element.

Patricia Wachter, M.A., CT/HT(ASCP)
Quality Assurance Specialist
Continuous Quality Improvement
Johns Hopkins Hospital

I attended the “Quality Management Systems – Transitioning for the Future” workshop at the 2012 ASCP Conference. It was an informative workshop that gave us the tools to go back to our own lab and assure that our Quality Management System was meeting standards.  I came back with some recommendations for the Immunology Division on how to improve our quality systems.  We learned the “10 Basic Elements of Quality.”  One that interested me the most in the discussion was Step 10:  Continual Improvement.  An integral part of improvement in any lab is to be Pro-active, not Reactive.  When there tends to be a number of problems or errors, it is easy to blame staff on these errors, but the problem may be in the process or procedure.  When techs continue to make the same problems, it is imperative to determine the root cause.  Then when you find the cause, you select and implement a solution to prevent the re-occurrence!  Overall, I was pleased with the information that I received.  The instructors were very knowledgeable knowledgeable and pleasant.

Cathy Smith, MT(ASCP)
Clinical Laboratory Scientist III
Immunology Lab
Johns Hopkins Hospital

This year at the ASCP Workshop I learned the essential elements of a Quality Management System (QMS). Not only am I more aware of the impact of a well-established QMS in a medical laboratory, I now have the knowledge and skills needed to evaluate and teach others about the best ways to maintain quality in the Transfusion Medicine Division.   The QMS guidelines allow Clinical Laboratory Scientists to perform a better job in contributing to the best healthcare possible for patients at Johns Hopkins Hospital.

Alissa Arellano, MT(ASCP)
Clinical Laboratory Scientist
Transfusion Medicine Division
Johns Hopkins Hospital

I really enjoyed the workshop, Quality Management Systems Transitioning for the Future.  Quality Management is a fairly new topic, and I always wanted to have a better understanding of this aspect in the laboratory setting.  The speakers were knowledgeable and presented the content well.  The ten elements of quality management (ISO 15189) were explained and discussed in detail, and our speakers facilitated the Q & A session to ensure that everyone was at ease with the topic.  Then we all had to participate in small groups in hands-on practice to teach a three-year-old how to make a peanut butter and jelly sandwich from scratch, incorporating all basic elements of quality essentials!   As you can imagine, this exercise was fun and informative.  The speakers had an engaging approach and promoted interaction among the learners.   In my opinion, this workshop was definitely educational and valuable.

Sudi Soleimanpour, MT(ASCP)
Laboratory Supervisor, Technical Operations
Johns Hopkins Laboratories/Zone 1

 Become an Innovative Leader in Healthcare Today

Maria Brock and Karen Tilstra taught us how to be creative problem solvers and innovative thinkers.  We were introduced to the five steps of Design Thinking:   Empathize, Define, Ideate, Prototype, and Test.  The concept of empathy was enlightening.  I had been accustomed to the concept of voice of the customer (VOC), and somehow the word “empathy” carries a deeper meaning for me.  It was defined as “no solutions until you experience what the end user experiences.”  Rather than just listening to the problem, I must relate somehow to what is going on with the customer.  The definition of the problem arises out of the empathy.  Maria and Karen also talked about FeedForward as an alternative to Feedback.  The insight that comes from these comments is critical to moving the project forward.  They introduced yet another new concept of “Yes, and….,” in place of “No, but ….”  We can tell team members “Yes, that is a great idea and …..”  We are now acknowledging the thought process and giving credence to the effort, not shooting ideas down with a “No, but ….” 

Words are a very powerful weapon…. use them wisely.

Patricia Wachter, M.A., CT/HT(ASCP)
Q.A. Specialist
Continuous Quality Improvement
Johns Hopkins Hospital

Creative problem-solving is something that we all use daily, especially in Outreach, so I was excited to discover that ASCP was offering a workshop dedicated to this essential skill. All in all, the workshop was fun and somewhat informative, however, I think it lacked cohesiveness at times, and the concepts and objectives weren’t always very clear or understandable. To be quite honest, the length of the workshop could have been shortened, too. We participated in various “hands on” projects to emphasize the concepts of innovation and problem solving. We tried our hand at Ebru, a Turkish art technique that floats paint on water (also called paper marbling). We were told to create three paintings. Of course, the first painting turned out horribly because you wanted to get it finished in a hurry, and since it was the first time there were some mistakes made and some experimentation with the process. The second painting was better, but the third was “a masterpiece.”  The purpose of this exercise was to demonstrate how to prototype, evolve and improve when problem-solving. Usually your first design or step in problem solving is crude, but  as you progress through the steps, you eventually (hopefully) get to a desired endpoint after trial and error and understanding the steps along the way.

Bill Hartlove, MT(ASCP)
Lab Manager, Pathology Outreach
Department of Pathology
Johns Hopkins Medical Institutions

I really enjoyed the ASCP workshop on being an Innovative Leader in the Laboratory. The motto of the workshop was “Yes, and ….” instead of “No, but ….” It was not the normal setting of just sitting and listening. The interaction was great.  We use the tool of listening (feedback) and responding with “Thank You” only.   Good, bad, happy, or sad, I will work on becoming a better listener to improve the culture to shape Suburban Laboratory into a world-class laboratory.

Tabitha L. Little Baker, H(ASCP)^CM
Hematology Specialist
Suburban Hospital

“Become an Innovative Leader” was by far the best and most interactive ASCP workshop that I have ever attended.  The room was set up with many round tables where we sat amongst our peers in a group setting.  The workshop was led by a group of employees with many different backgrounds from Florida Hospital who were all part of their Innovation Team.  They directed our group in many activities that forced us to think creatively through brainstorming and “empathy thinking.”  We were forced to go outside of our comfort zone to solve problems.  By nature, MTs tend to be very introverted but it is important to look past this to be strong leaders in our work place.  We were all challenged to come up with a problem that is common in the lab.  Our group came up with the problem of mislabeled/unlabelled specimens.  We were then challenged to go outside the lab and interview people from other professions to find out how they may solve a similar problem.  This was difficult because on the surface this issue seems to only be unique to the laboratory setting but after brainstorming we came up with a few good ideas.  We talked to valet parkers at the mall to discuss how they might identify cars when drivers have lost their tickets.  We also interviewed an employee at the hotel to find out what their procedure is for identifying guests.  This activity forced us think outside of the box to help us come up with new solutions to a common problem.  When there is a problem in the lab, sometimes the best solution might come from other areas of the hospital.  After lots of brainstorming, our group came up with a device to help eliminate this issue.  Unfortunately, this was just a one-day workshop but if it had been longer I’m confident that our team could have continued to work on our project and perfect our idea much like the Florida Hospital Innovation Team does!

Katie Bratt, M.A., MT(ASCP)
Clinical Laboratory Scientist III
Flow Cytometry Lab
Johns Hopkins Hospital

Innovative Leadership workshop was by far the most creative, engaging and useful workshop that I have ever attended at ASCP!   Thanks to JHM for giving all of us at Suburban the opportunity to attend!!

Deborah Williams, MT(ASCP)
Laboratory QA Coordinator
Suburban Hospital

Our workshop entitled “Become an Innovative Leader in Healthcare Today” was far from an ordinary meeting.  The day included how to think outside of the box, how to take into account how others feel about their job, innovative problem-solving, and even making art and a Play-Doh zoo with fellow employees.  The presenters use a team approach to solving problems in their laboratory and hospital by including various positions in the problem-solving process.  They even remove their badges in meetings so everyone can feel like an equal.  Overall, it was a good meeting and demonstrated how thinking outside of the box and collaborating with others on an equal playing field can lead to better problem solving and better patient care.

Brandon Ellis, MLS(ASCP)^CM
Lead Clinical Laboratory Scientist
Microbiology Division
Johns Hopkins Hospital

The workshop’s objectives included applying design thinking, effectively seeking information to define and devise resolutions, loops in prototype and rapid feedback to creating effective solutions in the healthcare environment. The exercises were interactive allowing the participants to learn from one another; while saying “Thank you” along with “Yes, and…”  Leaders were encouraged to keep an open mind, an open heart, and an open will. Consequently, minimizing judgment, cynicism and eliminating fear leads to a culture without barriers and promotes   creativity. The leaders were in groups practicing “SOVO.”  The SOVO- Starter Statement (How might … ?) define problem from empathy, Owner (who is the owner[s]), Verb (creating positive thinking), and Objective (goal).  Each group defined a problem, assigned an owner, ideated (brainstorm), and analyzed whether the objective was met by providing feedback among the groups.  Testing the prototype and rapid feedback are key to innovative leadership, tweaking and moving on to the next problem, while learning from our successes as well as our failures.

Arneal Crocker, MSc
Department Manager, Transfusion Medicine
Suburban Hospital

Updates in Laboratory Medicine: Core Topics for CMP

I attended the CMP workshop, mainly to fulfill various lab discipline credits needed, but all the speakers were motivated, energized and made the workshop interesting and enjoyable. Not having been in Blood Bank or Micro for many years, yet the lectures were informative and understandable.  Being more geared in Heme, I especially enjoyed the first one with different blasts, reactive cells, and patient history. What did I take away from this?   I saw a micro filaria on a slide, when there are fragile cells in a smear, remake the smear using 20% albumin, better ways of utilizing platelet transfusions, and much, much more.  Bottom line, if there is something you can do to help a patient’s diagnosis or recovery, do it!

Shirley Fuller, CLS (ASCP)(CSMLS)
Lab Specialist, Flow Cytometry Lab
Johns Hopkins Hospital

I attended the course, Updates in Laboratory Medicine: Core Topics for CMP, at the ASCP Workshop on May 3.  It was great to have five different lecturers who shared their expertise on the following topics:  Clinical Hematology Cases; The Laboratory’s Role in Diagnosing, Treatment, and Prevention of Obesity in the U.S; Microbiology 2012: Look to the Past and Find the Future; and Current Trends in Platelet Transfusions.

The lecture on obesity was the one that impacted me most.  The projection is that by 2030 over 50% of Americans over 20 will be OBESE, not just overweight!  The lecture also taught the participants about the health consequences of obesity in regard to coronary artery disease, diabetes, childbirth complications, renal, liver, gall bladder, bone, joint and urinary disease. We were encouraged to eat healthy and be healthy.

For someone like me who requires CMP for my certification, this workshop is a boon to be updated and educated, and at the same time fulfills my ASCP requirements.  Thank you, Johns Hopkins, for giving me the opportunity to attend!

Cyrene Abcede, M(ASCP)^CM
CLS III
Transfusion Medicine Division
Johns Hopkins Hospital

Body Fluids: a Practical Approach

Body Fluids, A Practical Approach was an excellent, very informative seminar. The slides we received will serve as an excellent tool for in-service education.  The presenter of the Body Fluids workshop, Leilani Collins, Associate Professor, University of Tennessee Health Science Center in Memphis, was concise and explained the topic and concepts with clarity and ease.

Santiago Saez
Medical Technologist
Sibley Memorial Hospital

The ASCP body fluids workshop was presented by Leilani Collins, who is associate professor at the University of Tennessee Health Science Center, Memphis, TN.   The presenter reviewed identification of cells in cerebrospinal fluid (CSF), serous (pericardial, pleural, peritoneal, ascitic) fluid and synovial fluids.  Images of normal and abnormal, benign and malignant cells in each type of fluid and the significant crystals occurring in synovial fluid were included.

A brief presentation of findings in bronchoalveolar lavage specimen was also incorporated.  I learned that ciliated epithelial cells may be more easily identified in the counting chamber since they appear as moving cells. These cells indicate that the specimen was not collected in the right part of the lung.

The workshop had a very practical approach.  The handling of the various types of fluids (e.g., BAL containers should be open under biological hood), the specimen requirements, the preparation of the cytospin slides, and the QC were discussed.  The questions at the end of the workshop led to a stimulating discussion.  The workshop was a good review and will help me in my teaching CLS students and new employees.

Esther Lipsky, MT(ASCP)
Clinical Laboratory Scientist IV
Johns Hopkins Hospital

Get LEAN in the Laboratory

I attended the ASCP workshop, “Get Lean in the Laboratory”.   It was presented by Karen Young who was a most enjoyable and enthusiastic speaker.  I left there with several tools that I will be using to look for redundancies in order to streamline some processes.  Ms. Young emphasized the importance of getting input from the staff who are the end user for our internal processes. She divided us into six teams and we did several interactive exercises to demonstrate her points.  The whole room really enjoyed this, and we all walked away with more knowledge than when we came.  I was one of four lucky ones who won Driving Operational Excellence, a book in which she authored Chapter 13.

In all, this was one of the best seminars I have ever attended.  I want to thank JHHS for the opportunity and to let them know that was indeed money well spent.

Marie Moninger, MT(ASCP)
Core Lab Supervisor
Suburban Hospital

Blood Bank: Optimizing Your Role in Transfusion Safety

Assistant Professor Michelle Brown of the University of Alabama presented this Blood Bank workshop in an effort to educate participants on the importance of  transfusion safety.  The workshop began with an evaluation of blood utilization practices, moved into the analysis of serological and clinical case studies, in addition to transfusion reactions, error reporting, and antibody workups. The lecture touched on all areas of the Blood Banking spectrum, and with a few stories of transfusions-gone-wrong thrown in the mix, proved to be both informative and entertaining.

Krystina Patterson, MT(ASCP)
Clinical Laboratory Scientist
Division of Transfusion Medicine
Johns Hopkins Hospital

After the first successful human-to-human blood transfusion in1818, transfusions became an integral part of lifesaving procedures.  Today, one unit is transfused every two seconds and transfusion safety has become the highest priority.  The focus on decreasing the risk of disease transmission during transfusion was pushed to the forefront by the public after the introduction of AIDS in the 1980s.  Today donors are screened thoroughly before donation by undergoing a physical exam and a donor history examination.  After the donation, samples of the blood are tested for Hepatitis, HIV 1 and II, West Nile, Syphilis, CMV, and antibody to T. cruzi.  Patients are screened and possible antibodies are identified, when feasible, before transfusion of blood products to provide low-risk transfusions.  The FDA currently monitors all Blood Banks with special emphasis on any transfusion reactions that occur.  Blood utilization committees, whose members comprise a variety of sources, were also put in place as well for peer review of transfusions.   Transfusion audits are performed on all units, to watch the transfusion process from start to finish.  This audit is usually done by members of the blood bank.  Transfusion safety is the top priority to ensure patient safety standards are being met.

Caitlin Kelly, B.S., MLS(ASCP)^CM
Clinical Laboratory Scientist III
Transfusion Medicine Division
Johns Hopkins Hospital

On Friday May 4, I attended the Blood Banking ASCP conference on Optimizing Your Role in Transfusion Safety. As a current blood banker and SBB student here at Hopkins, I was not sure if the lecture would be geared more toward those with very little blood banking experience, covering the basics, or if it would be more advanced.  I was very impressed to see that the lecture given by Michelle Brown was given in such a way that no matter your blood banking background, there was an opportunity to learn about both basic and advanced topics by reviewing various blood bank policies, processes, and procedures, and by going through case studies. She also allowed the audience to discuss, share opinions, and give different ideas on current variations in processes and topics. I learned a lot during the conference not only from Michelle but from those attending that were willing to share and give ideas. Overall, I think this was an excellent lecture to attend, no matter if you worked in a Chemistry lab and were attending to keep up on continuing education or were an SBB looking for a good review in important blood banking issues.

Heather Smith, MLS(ASCP)
Clinical Laboratory Scientist III, SBB Student
Transfusion Medicine Division
Johns Hopkins Hospital

The conference I attended was very informative and interesting.  Two areas covered that were highlights for me were blood utilization and laboratory diplomacy.  The workshop included valid ideas, methods, and examples for maximizing usage of our limited blood resources by getting hospitals (i.e., doctors) to minimize their transfusion orders to better suit actual patient needs.  There was also a good discussion on improving the poor lab-doctor-nurse relationships often seen in hospitals which have a very negative impact on patient care and employee satisfaction.

Victoria Humenik
Lead Medical Technologist
Transfusion Medicine Division
Johns Hopkins Hospital

I attend the ASCP conference, Blood Bank: Optimizing Your Role in Transfusion Safety.  The conference was a great resource which can help me in my everyday work setting.  The conference had a very knowledgeable speaker, Michelle Brown. She had an excellent presentation planned such as reading panels of mixed antibodies.  I hope to use all the knowledge that I got at the conference every day at work.

Thank you for such a great resource.

Keya Dalal, M.S.
Medical Technologist
Transfusion Medicine
Suburban Hospital

The Blood Bank seminar was very good.   The speaker, Michelle Brown, was a very excellent presenter. She gave us a lot of helpful tips and suggestions which are very helpful for Blood Bank techs.  As an example, she suggested that a person from the Blood Bank should follow a unit for patient transfusion to the floor, then observe if the nurses are following the SOP for transfusion.   It would be very good practice for patient care.

I learned a lot from the workshop and am thankful that I was able to attend.

Violeta Z. Moncada, MT
Blood Bank
Sibley Memorial Hospital

One of the key points our speaker, Mrs. Brown, mentioned was the need to educate physicians on how to reduce the number of unnecessary cross-matches ordered on patients, for instance, low Hct/Hgb does not always mean the patient needs a blood transfusion unless it is accompanied by underlining disease, trauma, or surgery. Transfusion reactions and antibody introductions (caused by transfusion) could be avoided if other options are used to correct the problem prior to blood transfusion.

Almaz Asgedom
Medical Technologist
Sibley Hospital