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- This is Lab Medicine Rounds,
a curated podcast for physicians, laboratory professionals,
and students.
I'm your host, Justin Kreuter, the Bow Tie Bandit of Blood,
a transfusion medicine pathologist at Mayo Clinic.
Today we're rounding with Ellen Dijkman Dulkes.
Ellen is a consultant for Mayo Clinic Laboratories
outreach and network development team.
And she's here to discuss rapid reference laboratory
development.
Thanks for joining us today, Ellen.
- Hey, Dr. Kreuter, nice to be here today.
Thanks for the invite.
- So Ellen and I are actually good old colleagues.
So where I did my residency at Dartmouth Hitchcock,
that's where I first met Ellen and we were just discussing
that it's been 10 years and so this show
is a fun one for me, both personally and professionally.
- Yeah. It's great to see you again, Justin. It's awesome.
- So Ellen, maybe can start us off by this concept of
rapid reference laboratory development.
Why is reference laboratory testing important for
physicians, laboratorians to understand?
- That's a good question.
So no laboratory does all the testing
in their own laboratory.
So we partner with other laboratories and other providers
that work with that laboratory locally to do that expanded
test menu for them.
And what happens is patients want to get their care in the
area that they see their doctor and because labs don't do
all the testing themselves,
Mayo Clinic Labs then becomes the reference lab to provide
that state-of-the-art testing for that clinician to get
their lab tests done.
- You know, I think that's an important point.
I'm glad you brought that up.
No lab does all the testing, I know, in the last 10 years
actually I've gotten feedback as we get feedback from
the physicians we work with and I actually got that
written feedback is for what tests we should bring in
was all lab tests.
And that's a really important concept for people to
understand is that labs really can't have that kind
of a panel
It just doesn't make sense, right?
- Yeah, financially, it doesn't make sense.
You may see a specialized test once in a blue moon or a few
times a year.
And by the time you buy the equipment and you train staff to
do that test, then your cost per test goes really up.
What Mayo does though, is we do encourage labs, based on
their volume to bring tests in whenever possible.
We want the patient to get the care at the right time at the
right place.
But for those tests that they can't do,
we want them to send to Mayo.
And actually this was a really great model when I was at
Dartmouth Hitchcock and you were there.
I was the outreach manager and the state of New Hampshire
is a very small state, but we have many couriers that come
into the lab daily.
And then those tests that we don't perform or didn't perform
in Lebanon would then go to Mayo.
And Mayo has a infrastructure with a courier to pick up
specimens, take to Rochester, and then really by next day,
in a lot of cases, the clinicians getting the results
or shortly thereafter.
We also have a subspecialty pathology service, as you know,
at Mayo, similar to Dartmouth.
So the relationship between a pathologist and clinician is
really important.
We also support the pathologist, you know,
so if they need a second opinion, Justin,
you can probably speak more to it on that,
but you've got to phone a friend, a person to call.
- Yeah, you know, and I'm glad you brought that up too,
because that's actually, one of the themes of this podcast
is our tagline is connecting lab medicine to clinical
practice through insightful conversations.
And really that's at the heart of what you're talking about
with reference lab.
And I liked that you brought up this dynamic of those
conversations may be with physicians and distant practices,
that might be between pathologists.
So intra or inter specialty kind of conversations.
Now you were talking about, why you might organize,
some lab tests locally and,
then what should go out to a reference lab.
And you've been involved in this intimately
for a number of years.
What have we really learned in the last couple of years
about reference laboratories?
How we can really best support clinical practice, right?
You mentioned that of, having that answers as quick as
possible for the patient in their care.
- Yeah, I guess I would look at external labs
and there are two different kinds.
There's reference lab testing, and then there's
commercial lab.
And Mayo sets itself apart from the commercial lab, in that
we do the partnership and education.
Where a commercial lab, they may set up a draw station
across the road from you and compete for the same work.
We really want the local laboratory to see the bulk of the
front end; interface with the patient.
But, you've seen one lab, you've seen one lab
and what makes Mayo Clinic Labs so much different is that
we've partnered with labs across the country that really
gives us the expertise to be helpful resources to lab staff
to grow their outreach business.
- You know, it sounds like the relationship you're
highlighting is one of the really important things that
we've kind of learned on how you do that, right?
Because that's how you're highlighting that as a reference
lab, you're really providing that expertise
to the kind of local provider.
Is there any sort of, how that gets done?
That that has worked better?
You know, I imagine there's always some missteps that happen
or ways that it works better or worse.
And do you have any insights for how
that communication goes?
- Well, the world I work in, I don't really,
I'm not really interfacing with the providers.
I really am working lab to lab, with the lab leadership
to maybe look at opportunities for improvement with
their call center or logistics with courier and,
the temperatures that you ship specimens so that the lab,
when they do the testing has a specimen, that's at the right
temperature and shipped properly, patient identification.
We really work on educating the laboratory so that they can
be a better resource to their clients.
- Yeah, that's brilliant.
I think a lot of things kind of fall down there is you're
kind of talking about specimen transport, we got it;
It's in the wrong tube.
I deal with that all the time is getting a sample in the
wrong tube and we're not validated for that sample type.
And, I just, you just get a pain in your heart because
this means, really a recollect and delay of
getting that answer that somebody wanted.
And so I guess what you're pointing at is that there's a
whole team of people with reference laboratories working on
this interface so that, these sort of errors are not
repeated and it's really in the patient's benefit,
it sounds like.
- Yeah, we really focused on the pre-analytic.
So everything that happens prior to the specimen being
collected and so think about what that means.
It's getting a proper requisition.
It's getting the right temperature, specimen delivered.
It's the right sample type.
It's not collected in a blue top when it should have been
collected in a purple top.
And then post analytic; we work in that world,
about the bills and about the resulting and
getting reports to the right clinician.
So we don't really deal with the analytic piece of it as
much as we deal with the pre and post, with outreach.
- So speaking to our listeners, right?
We've got laboratorians, physicians that are listening to
this as well.
How might, a hospital laboratory kind of partner
and collaborate with their reference laboratory?
I can imagine, that sometimes it just seems like,
it's that expression of what it it's a send out and
it just sort of almost feels like it's out of your hands,
you know, what can I do?
But it sounds like what you're telling us here today is
there's a lot of potential for collaboration
and quality improvement.
And so how might a hospital kind of reach out and partner?
What are the ways to do that with their reference lab?
- The biggest thing immediately short term,
September 28th and 29th Mayo Clinic Laboratories is hosting
a conference, Leveraging the Laboratory.
And we are really going to be talking about the pandemic and
then the resilience post pandemic.
We have a speaker that's coming to talk to us about how they
partnered with the PGA to do COVID testing.
We are going to talk about legal issues.
A lawyer for Mayo Clinic Labs is going to be talking about
things we should know, so that we're compliant.
We're going to have breakout sessions that talk about what I
was just highlighting; logistics, courier, billing,
customer support.
And so there'll be breakout sessions that you can sign up
for and participate.
And then really outreach is really networking and, you know,
having someone to work with.
So I think the Leveraging the Lab conference is really a
wonderful way that folks can start to understand how others
are doing it.
You know, so it'll watch one, do one, teach one.
Robert Michelle is going to be there and he needs
no introduction.
Robert Michelle will be talking about outreach and
what's going on in the world.
And so I think it's a really value added conference.
If you are able to attend or to get folks in your world to
attend, they can register.
And I think at least, starts the discussion about outreach
and how you can do things better.
- That's really wonderful because it sounds like you say,
you can pick up the phone and reach out to your lab.
And certainly I encourage everybody to do that too,
as Ellen is saying to network and build this relationship
that the reference laboratories are eager to do that.
But also, I mean, it sounds like this conference is really
a rich place to not only hear answers and ask questions,
but also to hear what other people are asking and talking
about as well.
So Ellen, I was wondering, looking into your crystal ball,
you have a wealth of experience and background,
and you're going to be talking at this conference about
this, rapid reference laboratory development.
What does the future of reference laboratories look like?
Do you think this is a really dynamic environment for our
physician listeners' reference laboratories?
This is a very dynamic area of medicine and healthcare these
days, so Ellen, what do you think might be in store for us?
- Well, I think partnerships are going to play
a critical role.
Many hospitals are partnering in their local area or across
their state with other institutions to get efficiencies of
scale, working leaner.
Maybe they don't all do one test, but they may do some
test sharing and consolidation, even around equipment and
standardization of equipment and results.
I think that in the short term is really important,
but long-term, I think having a reference laboratory that
partners with you, we compete on quality service,
price and value.
And value, I think, value for the money is going to play
a pivotal role.
And I think Mayo Clinic Labs is really set up well
to offer value.
Mayo Clinic Labs is set up to really be a partner for
reference lab testing for hospitals.
We want to serve patients in your community and we succeed
when local laboratories succeed.
So I think we can add value to the patient experience by
being your silent partner.
- That's wonderful and well said.
I feel like this highlights really for our full audience.
I think this conversation with you today,
you've really kind of shed this light on,
I think for our physician listeners that, why we do we have
reference laboratories.
And I think that you've really built that bridge for helping
them to understand that they can reach out to whoever is
that reference laboratory; pick up the phone.
You should be able to talk with somebody,
get somebody that has answers for you and can help you
navigate your questions for the laboratorians that are
listening to this, I mean, I think you're also showcasing
not only the upcoming conference, which I think is a really
cool opportunity, but you're also highlighting the fact that
they too can pick up the phone and the reference laboratory,
Although, you know, there might be this perception of this
kind of ivory tower or something, and far off
in the distance that the reference laboratory is
really eager to partner.
And I think that maybe it works in both directions.
Sometimes the reference laboratory doesn't really know who
the right person to contact on your end might be.
And so again, sort of starting those introductions,
Ellen, you brought up the idea of networking.
And I think that's something that our student listeners can
kind of take away from this as well.
As well as learning about this kind of unique, and I like
the idea you brought up the laboratory as the silent partner
for clinical medicine.
- Yes, definitely.
- And, for our students, this is something that I think,
I mean, I remember as a medical student,
the laboratory was still a black box,
even as a fourth year medical student going into pathology.
And so it's something that's really behind the scenes,
but I think this hopefully kind of gives you an idea of the
landscape and probably also Ellen's stress of the,
networking and the relationships,
which is kind of going to be valuable no matter what you're
doing in medicine.
So thank you so much, Ellen.
I really appreciate this today.
- Yeah, no question is a dumb question.
You know, it's really, if you want to know the answer,
reach out to the right people that can give you that answer
because ultimately we all want the patient and the patient
care team to succeed.
- We've been rounding with Ellen Dijkman Dulkes
on rapid reference laboratory development.
Thank you for taking the time to talk about this with us,
To our listeners, we thank you for joining us today.
We invite you to share your thoughts and suggestions by
email.
Please direct any suggestions to mcleducation@mayo.edu.
If you've enjoyed Lab Medicine Rounds podcasts,
please follow or subscribe until our next rounds together.
We encourage you to continue to connect lab medicine and the
clinical practice through insightful conversation.
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