What do you do when the proverbial stool sample hits the rotary ventilation device and ALL your IT stops working, yep all of it, all at once!? What happens when the laboratory computer system locks everyone out and you can’t put results in or look results up? What can you do when the fancy piece of automation that moves agar plates around the lab like some kind of daemonic sushi bar fails because of a power cut?
What would you do? Burst into tears? Swear profusely? Run screaming to the nearest pub? Sing a jolly pop song?
What would you do? Burst into tears? Swear profusely? Run screaming to the nearest pub? Sing a jolly pop song?
Well, maybe it helps to be a little bit old-fashioned and remember what life was like before all of this IT came along… nowadays it’s called contingency planning, back in the day it was normal practice….
The problems with modern day pathology
Okay, I could go on and on about this, but I’ll try and stay on topic 😊
Pathology laboratories are just TOO BIG! There has been a trend since the mid-1990s, following the Carter Report, to merge pathology laboratories to make use of economies of scale. The idea of Lord Carter was to make tests cheaper by having them done in large batches at big centres so as to bring the cost/test down. This then would save money that could be invested back into the pathology services. Lord Carter was very clear; this was about investing in pathology… However the problem was that everyone else heard “save money, blah, blah, blah”. Services were merged and the investment didn’t come, then they were merged again and again and yep, you guessed it, investment was never a priority. The result is we now have a few massive laboratories that have workloads so big that if they have a problem the workload is too much for anyone else to take on and no “neighbour” exists to help out, so the service fails. BOOM!!
I believe there is an over-reliance on technology. Everything in the modern healthcare service runs on computers, even old-fashioned paper patient notes are becoming a thing of the past. And this is good in some ways; has anyone else dropped 3 volumes of paper notes all over the floor and then had to try and get them back in chronological order using those odd plastic paper fastener-thingies? No, only me then?! Hey, those things have a name “Jalema paper fastener”…who knew? and they still sell them!! So what happens when the power goes off, or the computer breaks, or the various different pieces of software stop talking to each other for some reason. What happens if a virus gets into the system (no, not SARS CoV2, a computer virus!)? When IT systems fail, they can bring down the whole system.
The problems with modern day pathology
Okay, I could go on and on about this, but I’ll try and stay on topic 😊
Pathology laboratories are just TOO BIG! There has been a trend since the mid-1990s, following the Carter Report, to merge pathology laboratories to make use of economies of scale. The idea of Lord Carter was to make tests cheaper by having them done in large batches at big centres so as to bring the cost/test down. This then would save money that could be invested back into the pathology services. Lord Carter was very clear; this was about investing in pathology… However the problem was that everyone else heard “save money, blah, blah, blah”. Services were merged and the investment didn’t come, then they were merged again and again and yep, you guessed it, investment was never a priority. The result is we now have a few massive laboratories that have workloads so big that if they have a problem the workload is too much for anyone else to take on and no “neighbour” exists to help out, so the service fails. BOOM!!
I believe there is an over-reliance on technology. Everything in the modern healthcare service runs on computers, even old-fashioned paper patient notes are becoming a thing of the past. And this is good in some ways; has anyone else dropped 3 volumes of paper notes all over the floor and then had to try and get them back in chronological order using those odd plastic paper fastener-thingies? No, only me then?! Hey, those things have a name “Jalema paper fastener”…who knew? and they still sell them!! So what happens when the power goes off, or the computer breaks, or the various different pieces of software stop talking to each other for some reason. What happens if a virus gets into the system (no, not SARS CoV2, a computer virus!)? When IT systems fail, they can bring down the whole system.
Added to this we have less staff to deal with the workload. A consequence of both of the above is that people have been replaced with machines and merged. I understand that some labs have problems recruiting due to the local costs of living etc., and that machines can run 24/7, but people matter. Trained lab staff really matter! The lab staff I have worked with over the years are amazing. They are highly skilled, highly qualified and highly conscientious. And like one of my old mentors in Nottingham once said in a laboratory talk “give me a person over a machine any day of the week”… see Bob, I was listening!
So, what do you do when the stool sample hits the rotary ventilation device? You go back in time…
Back to the future
When I started in microbiology 21 years ago pretty much everything was done with pens and paper. Okay, we used agar, and sugar tests, and Gram stain, but you’re missing the point…
Requests forms for specimens sent to the lab had hand-written numbers marked on the front of the form, and then the same number was hand-written on all the agar plates and other tests for that specific sample. This was time consuming and prone to possible error if the wrong number was written down, but surprisingly this very rarely happened.
Once specimens had been set up on agar, or any other tests, the plates were stacked in specimen number in metal holders and loaded into large incubators. If there was a problem with an incubator, then there were plenty of others to use, there was capacity. The biggest problem would occur if you dropped a stack of plates, (I wasn’t allowed into the lab too frequently for obvious reasons) but it didn’t take long to pick them up and sort them again. The main issue way back then was the time it took to stack, load and unload the incubators, or find the specific plates you were looking for. That could take ages!
When the lab staff were working on a sample, they documented any results on the back of the request form sent down to the lab with that sample. They often used lab shorthand such as STAA for Staphylococcus aureus, GAS for Group A beta-haemolytic streptococcus, or my favourite Nottingham-ism Pyo for Pseudomonas spp. (from the chemicals pyocyanin, pyoverdin, pyorubin, etc that the bacterium produces). Very Olde fashioned Microbiologists like me still use the term “back of form” to refer to the results of tests done and the work in the lab on specimens that aren’t going to be reported out to the user. Admittedly, most modern lab staff look at me oddly without a clue what I’m wittering on about…
The lab also printed daily work lists using a dot-matrix printer (remember those?) and A3 concertina paper. This kept the results in numerical order and provided a single reference for what was going to be reported on the result later. Again, much of this was in lab shorthand. The worksheets were kept chronologically in a plastic A3 ring binder until all of the samples on that sheet were finished then it was filed away. These lists were essential though, and if the computers or printers failed it wasn’t a big deal, we still had the back of form.
When the specimen had been processed the lab staff and the Microbiologists sat down together on the “bench round” and decided how best to report the result. I love bench rounds, they are such fun. This is when we did the BBC Radio 2’s daily pop master quiz together too. Okay, so we did then use computers as the results were then uploaded to a computer to be sent back to the user, but any urgent results were telephoned to the user if they had put their contact details on the form, or the ward if not… so we did have computers…an “old BBC computer with a tape drive” or something modern like Windows95 J.
So, what does a contingency service look like?
Well, funnily enough, a contingency service in Microbiology looks just like an old-fashioned laboratory, but without the pop quiz!
All specimens and agar plates are hand labelled. Tests are loaded manually into incubators. Results are written down on paper using pens or pencils. Urgent samples and tests are prioritised (usually sterile fluids and CSF as well as blood cultures). Important results are telephoned to the clinical teams or wards where the patients are located.
Easy! So, what is the problem?
Okay, the actual handling of the tests isn’t too bad. One problem now, which we never faced before, is that the lab is often handling the workload of multiple hospitals and GPs, This now all comes in “continuously” as we have added capacity of hours and automation even though there is in fact A PROBLEM! Then factor in that the workforce has been significantly reduced to fund these fancy pieces of IT that now aren’t working!!!
In reality, “A PROBLEM” means not everything can be done and so contingency often involves choosing what not to process. Added to the shrinking hours of the 48 hour weekend-from-hell shift is the fact that “those significant” results need telephoning out to different hospitals, which means negotiating hospital switchboards which are always extremely busy, and this is very time consuming. And finally, when the IT starts working again (Monday morning!!), all of those paper results need manually entering into the IT systems and this takes a massive amount of time, is prone to transcription errors, and has to be done whilst all of the new days work has just arrived from all of the hospitals and GPs covered by the laboratory.
So, merging labs with a reliance on IT might be good when everything is working, but when the IT stops working it is the lab staff who have to manage the situation, and it always amazes me how well they do. I was even e-mailed to say the lab had sent me chocolates… then I was reminded this was the results of the chocolate agar plates (lab staff can occasionally disappoint me too!)
So yep, I’m with Bob, give me people over machines every day of the week… and if all else fails try some “percussive maintenance” and hit the machine with a bigger hammer! It may not work, but it might make you feel better!
So, what do you do when the stool sample hits the rotary ventilation device? You go back in time…
Back to the future
When I started in microbiology 21 years ago pretty much everything was done with pens and paper. Okay, we used agar, and sugar tests, and Gram stain, but you’re missing the point…
Requests forms for specimens sent to the lab had hand-written numbers marked on the front of the form, and then the same number was hand-written on all the agar plates and other tests for that specific sample. This was time consuming and prone to possible error if the wrong number was written down, but surprisingly this very rarely happened.
Once specimens had been set up on agar, or any other tests, the plates were stacked in specimen number in metal holders and loaded into large incubators. If there was a problem with an incubator, then there were plenty of others to use, there was capacity. The biggest problem would occur if you dropped a stack of plates, (I wasn’t allowed into the lab too frequently for obvious reasons) but it didn’t take long to pick them up and sort them again. The main issue way back then was the time it took to stack, load and unload the incubators, or find the specific plates you were looking for. That could take ages!
When the lab staff were working on a sample, they documented any results on the back of the request form sent down to the lab with that sample. They often used lab shorthand such as STAA for Staphylococcus aureus, GAS for Group A beta-haemolytic streptococcus, or my favourite Nottingham-ism Pyo for Pseudomonas spp. (from the chemicals pyocyanin, pyoverdin, pyorubin, etc that the bacterium produces). Very Olde fashioned Microbiologists like me still use the term “back of form” to refer to the results of tests done and the work in the lab on specimens that aren’t going to be reported out to the user. Admittedly, most modern lab staff look at me oddly without a clue what I’m wittering on about…
The lab also printed daily work lists using a dot-matrix printer (remember those?) and A3 concertina paper. This kept the results in numerical order and provided a single reference for what was going to be reported on the result later. Again, much of this was in lab shorthand. The worksheets were kept chronologically in a plastic A3 ring binder until all of the samples on that sheet were finished then it was filed away. These lists were essential though, and if the computers or printers failed it wasn’t a big deal, we still had the back of form.
When the specimen had been processed the lab staff and the Microbiologists sat down together on the “bench round” and decided how best to report the result. I love bench rounds, they are such fun. This is when we did the BBC Radio 2’s daily pop master quiz together too. Okay, so we did then use computers as the results were then uploaded to a computer to be sent back to the user, but any urgent results were telephoned to the user if they had put their contact details on the form, or the ward if not… so we did have computers…an “old BBC computer with a tape drive” or something modern like Windows95 J.
So, what does a contingency service look like?
Well, funnily enough, a contingency service in Microbiology looks just like an old-fashioned laboratory, but without the pop quiz!
All specimens and agar plates are hand labelled. Tests are loaded manually into incubators. Results are written down on paper using pens or pencils. Urgent samples and tests are prioritised (usually sterile fluids and CSF as well as blood cultures). Important results are telephoned to the clinical teams or wards where the patients are located.
Easy! So, what is the problem?
Okay, the actual handling of the tests isn’t too bad. One problem now, which we never faced before, is that the lab is often handling the workload of multiple hospitals and GPs, This now all comes in “continuously” as we have added capacity of hours and automation even though there is in fact A PROBLEM! Then factor in that the workforce has been significantly reduced to fund these fancy pieces of IT that now aren’t working!!!
In reality, “A PROBLEM” means not everything can be done and so contingency often involves choosing what not to process. Added to the shrinking hours of the 48 hour weekend-from-hell shift is the fact that “those significant” results need telephoning out to different hospitals, which means negotiating hospital switchboards which are always extremely busy, and this is very time consuming. And finally, when the IT starts working again (Monday morning!!), all of those paper results need manually entering into the IT systems and this takes a massive amount of time, is prone to transcription errors, and has to be done whilst all of the new days work has just arrived from all of the hospitals and GPs covered by the laboratory.
So, merging labs with a reliance on IT might be good when everything is working, but when the IT stops working it is the lab staff who have to manage the situation, and it always amazes me how well they do. I was even e-mailed to say the lab had sent me chocolates… then I was reminded this was the results of the chocolate agar plates (lab staff can occasionally disappoint me too!)
So yep, I’m with Bob, give me people over machines every day of the week… and if all else fails try some “percussive maintenance” and hit the machine with a bigger hammer! It may not work, but it might make you feel better!
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