One med tech on weekend night shift? 200 bed hospital. Good / decent / or awful idea?

[Torsed]

My great visionary administrators without consulting myself first, have decreed to put one med tech to run the our whole hospital lab on weekend nights alone. Granted, it is generally the lower end of volumes at this time, but.....

This shift does include more BB, chemistry, routine coag, with lesser degrees of Heme and Micro for a 200 bed hospital.

Med tech initially assigned to work weekend nights is fairly seasoned, but not a superstar, I have doubts about the tech running multiple departments with fear of BB mistake (who wouldn't). The lab is not laid out well and is choppy so there is a lot of running around corners in various departments.

This town/hospital averages about 100 ER visits a day, has an active knife and gun club, several OB/Gyn's with at least two separate groups on call, and there is always an ortho and general surgeon on paid trauma call, level III trauma center with a reluctance to transfer, and an ICU and a step down PCU.

I told them I would not do one med tech to support all the above departments. The answer was to have a back up tech on call that they are not paying for call (that's a hoot). This laboratory does run over 300k billable laboratory tests a year.

My opinion was no and they are looking to get into hot water, maybe what one would call managerial derailment here.

Curious to other opinions. Is this common in your laboratories? Similar struggles anywhere?

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[wholeheartedly]

My great visionary administrators without consulting myself first, have decreed to put one med tech to run the our whole hospital lab on weekend nights alone. Granted, it is generally the lower end of volumes at this time, but.....

This shift does include more BB, chemistry, routine coag, with lesser degrees of Heme and Micro for a 200 bed hospital.

Med tech initially assigned to work weekend nights is fairly seasoned, but not a superstar, I have doubts about the tech running multiple departments with fear of BB mistake (who wouldn't). The lab is not laid out well and is choppy so there is a lot of running around corners in various departments.

This town/hospital averages about 100 ER visits a day, has an active knife and gun club, several OB/Gyn's with at least two separate groups on call, and there is always an ortho and general surgeon on paid trauma call, level III trauma center with a reluctance to transfer, and an ICU and a step down PCU.

I told them I would not do one med tech to support all the above departments. The answer was to have a back up tech on call that they are not paying for call (that's a hoot). This laboratory does run over 300k billable laboratory tests a year.

My opinion was no and they are looking to get into hot water, maybe what one would call managerial derailment here.

Curious to other opinions. Is this common in your laboratories? Similar struggles anywhere?

As a med tech, I've seen one tech used for a much smaller 24 bed critical access hospital and even they decided it was a bad idea. My current facility is also critical access and there are no techs at night, just someone on call. It apparently works here, but we have very low volumes in the ED and inpatient at night so it has been ok, but the lab manager wants to change that. We do no surgeries, no ICU, and anything major gets stabilized and transferred, very low transfusion rate.

One bleeder will pull the tech predominately to BB and everything else will get pushed aside. Nights is also when a lot of routine maintenance gets done because of the lower volume and also when analyzer issues can crop up which again will tie up your tech. You really need someone skilled and highly efficient or it's going to be a struggle. If you want to keep turnover down, this person should ideally get a lunch break. I would also check the state and fed labor laws to make sure they can have someone unpaid on call. It might also run against institutional policy. At the very least it's usually standard most places to offer some on call compensation so it's going to piss your techs off not to get it. might increase turnover and therefore costs.

I also worked at a major medical center in a core lab with with a 500,ooo per month test wolume with two techs on night. That went ok for most nights, but was a challenge if one of the major analyzers went down or a LIS outage happened, etc. They tried to drop it to one for the holidays, but found it just wasn't manageable.

So, it might be possible to run with one on weekends, but it's probably going to be painful.

 

[deleted314957]

My great visionary administrators without consulting myself first, have decreed to put one med tech to run the our whole hospital lab on weekend nights alone. Granted, it is generally the lower end of volumes at this time, but.....

This shift does include more BB, chemistry, routine coag, with lesser degrees of Heme and Micro for a 200 bed hospital.

Med tech initially assigned to work weekend nights is fairly seasoned, but not a superstar, I have doubts about the tech running multiple departments with fear of BB mistake (who wouldn't). The lab is not laid out well and is choppy so there is a lot of running around corners in various departments.

This town/hospital averages about 100 ER visits a day, has an active knife and gun club, several OB/Gyn's with at least two separate groups on call, and there is always an ortho and general surgeon on paid trauma call, level III trauma center with a reluctance to transfer, and an ICU and a step down PCU.

I told them I would not do one med tech to support all the above departments. The answer was to have a back up tech on call that they are not paying for call (that's a hoot). This laboratory does run over 300k billable laboratory tests a year.

My opinion was no and they are looking to get into hot water, maybe what one would call managerial derailment here.

Curious to other opinions. Is this common in your laboratories? Similar struggles anywhere?

The situation you describe is unsat. You might want to have a quiet talk with the hospitals risk management folks and try to head off the train wreck.

 

[LADoc00]

My great visionary administrators without consulting myself first, have decreed to put one med tech to run the our whole hospital lab on weekend nights alone. Granted, it is generally the lower end of volumes at this time, but.....

This shift does include more BB, chemistry, routine coag, with lesser degrees of Heme and Micro for a 200 bed hospital.

Med tech initially assigned to work weekend nights is fairly seasoned, but not a superstar, I have doubts about the tech running multiple departments with fear of BB mistake (who wouldn't). The lab is not laid out well and is choppy so there is a lot of running around corners in various departments.

This town/hospital averages about 100 ER visits a day, has an active knife and gun club, several OB/Gyn's with at least two separate groups on call, and there is always an ortho and general surgeon on paid trauma call, level III trauma center with a reluctance to transfer, and an ICU and a step down PCU.

I told them I would not do one med tech to support all the above departments. The answer was to have a back up tech on call that they are not paying for call (that's a hoot). This laboratory does run over 300k billable laboratory tests a year.

My opinion was no and they are looking to get into hot water, maybe what one would call managerial derailment here.

Curious to other opinions. Is this common in your laboratories? Similar struggles anywhere?

Uhhh that is literally insane. There is no way I would ever ever man a 200 bed hospital lab at any time, even in a national disaster like an alien invasion with less than 2-3 folks.

Where the hell in the country are you? Like rural Alabama??

 

[y2k_free_radical]

My great visionary administrators without consulting myself first, have decreed to put one med tech to run the our whole hospital lab on weekend nights alone. Granted, it is generally the lower end of volumes at this time, but.....

This shift does include more BB, chemistry, routine coag, with lesser degrees of Heme and Micro for a 200 bed hospital.

Med tech initially assigned to work weekend nights is fairly seasoned, but not a superstar, I have doubts about the tech running multiple departments with fear of BB mistake (who wouldn't). The lab is not laid out well and is choppy so there is a lot of running around corners in various departments.

This town/hospital averages about 100 ER visits a day, has an active knife and gun club, several OB/Gyn's with at least two separate groups on call, and there is always an ortho and general surgeon on paid trauma call, level III trauma center with a reluctance to transfer, and an ICU and a step down PCU.

I told them I would not do one med tech to support all the above departments. The answer was to have a back up tech on call that they are not paying for call (that's a hoot). This laboratory does run over 300k billable laboratory tests a year.

My opinion was no and they are looking to get into hot water, maybe what one would call managerial derailment here.

Curious to other opinions. Is this common in your laboratories? Similar struggles anywhere?

And i thought ours was bad

 

[Napoleon1801]

My great visionary administrators without consulting myself first, have decreed to put one med tech to run the our whole hospital lab on weekend nights alone. Granted, it is generally the lower end of volumes at this time, but.....

This shift does include more BB, chemistry, routine coag, with lesser degrees of Heme and Micro for a 200 bed hospital.

Med tech initially assigned to work weekend nights is fairly seasoned, but not a superstar, I have doubts about the tech running multiple departments with fear of BB mistake (who wouldn't). The lab is not laid out well and is choppy so there is a lot of running around corners in various departments.

This town/hospital averages about 100 ER visits a day, has an active knife and gun club, several OB/Gyn's with at least two separate groups on call, and there is always an ortho and general surgeon on paid trauma call, level III trauma center with a reluctance to transfer, and an ICU and a step down PCU.

I told them I would not do one med tech to support all the above departments. The answer was to have a back up tech on call that they are not paying for call (that's a hoot). This laboratory does run over 300k billable laboratory tests a year.

My opinion was no and they are looking to get into hot water, maybe what one would call managerial derailment here.

Curious to other opinions. Is this common in your laboratories? Similar struggles anywhere?

Agree with everyone else that this is a terrible idea and a recipe for disaster. This strategy might be appropriate for a 20-40 bed hospital, but all you need is one massive transfusion and no other labs are getting done. I would appeal to the C-suite and get someone to override this decision.

Otherwise, wait for a colossal failure and opportunity to get the resources you asked for to begin with.

 

[Med Director New England]

This wont work...Are you the medical director for the lab?

You should make your concerns known asap in a professional way and in writing (or either at a meeting with minutes).
One of my hospital has 100 beds, 10 bed ICU, bloodbank, full service ER and the thinnest we are staffed on the weekend is 2 MT + a lab tech (with at least an associate degree, so they can setup a lot of tests) and we have another MT on call that can be called in for a blood bank emergency. Similar to your lab coverage includes Chem, heme/coag, BB and micro. Resp therapy and phleb are separately staffed.
Your ED is much less busy than my ED but still you are dangerously understaffed

 

[Torsed]

Thank you for your comments. It is very similar geographically to rural Alabama. I voiced my opinion. We see if it is heeded.

 

[Torsed]

Follow up:

Couldn't get them (hospital leadership) to deviate from the one tech at weekend night idea. I did meet with senior administration and documented we met, and warned them of my concerns and patient safety, also documented in an email to them.

Admin decided they will keep a back up tech on call if gets volume overloaded. I tell my friends I won't come to this hospital on weekend nights. :-/ You all know how long it takes anyone to roll in with a timely manner in the middle of the night, I am not optimistic.

Best I could do.

 

[deleted314957]

Those damned admins will squeeze a nickel ‘till the bull s****

 

[Dave CX]

Follow up:

Couldn't get them (hospital leadership) to deviate from the one tech at weekend night idea. I did meet with senior administration and documented we met, and warned them of my concerns and patient safety, also documented in an email to them.

Admin decided they will keep a back up tech on call if gets volume overloaded. I tell my friends I won't come to this hospital on weekend nights. :-/ You all know how long it takes anyone to roll in with a timely manner in the middle of the night, I am not optimistic.

Best I could do.

I always has the best results with email threads. Administrators are less stupid when more eyes are reading the same thing they are. Verbal discussions with your personal documentation is not strong enough. You need to do this because any disaster will be blamed entirely on you.

 

[Med Director New England]

Follow up:

Couldn't get them (hospital leadership) to deviate from the one tech at weekend night idea. I did meet with senior administration and documented we met, and warned them of my concerns and patient safety, also documented in an email to them.

Admin decided they will keep a back up tech on call if gets volume overloaded. I tell my friends I won't come to this hospital on weekend nights. :-/ You all know how long it takes anyone to roll in with a timely manner in the middle of the night, I am not optimistic.
—————-
Keep the email.

Won’t be long til you have a bleeder occupying your one tech and the on call tech still isn’t in the hospital and your ER doc is wondering why their troponins are taking so long on the patient who might be having an MI

 

[deleted314957]

I think this is serious enough that you really need to do something beyond what a bunch of us pathologists opine to be “the best course of action”. On my own dime i would consult with a specialized healthcare attorney and follow their advice. Trouble is coming and you need better advice then we can offer.

 

[Aminex]

MLS here. It takes so few mole hills to make mountains at night if you're alone. Platelet clumps/abnormal lympho/IG/blast flag in hemo, defective clotting curve that needs investigation, that warm auto that sits at a 5 hgb anyway comes in SOB and ED loses their s*&# about getting units, hungry hungry chem analyzers (calibrators/flex cartridges/etc), the 1,200 TPN glucose from the sloppy line draw, the rapid flu/RSVs that drip like water torture from December to March, speaking of drip: UA w/micro on everybody, et al. At a minimum, you're gonna have some screaming clinical staff and a suicidal/homicidal tech. At worst, someone is going to get delayed/incorrect results that will result in harm. Granted, I'm at a Level I that is 3x bigger with an ED that never clears its waiting room but I think the point stands. Your tech would need to be gooood and very well compensated. Hook them up with modafinil/phentermine/DA stim. of choice somehow.

 

[y2k_free_radical]

I think this is serious enough that you really need to do something beyond what a bunch of us pathologists opine to be “the best course of action”. On my own dime i would consult with a specialized healthcare attorney and follow their advice. Trouble is coming and you need better advice then we can offer.

May be that he does not want to incur the wrath of administration as a non team player.The oversupply of pathologists has vastly undercut our leverage.

 

[Torsed]

As mentioned above, I called a formal meeting about this with the Chief Quality officer, CFO, and CEO, I also had one of my partners attend so it can't be a me versus them alone in what was said. I painted a bleak picture of errors and showed them where it is happening. They are aware, but I feel the local admin don't want to anger the corporate admin people above them with increased costs etc. I am not sure what a path attorney would say we could do any differently, I've already told them frankly not to do this and they did.

I have used McDonnell-Hopkins group extensively in the past for pathology related risk/legal issues. I am a third party contractor, if the corporation wants to run their show into the ground I try to stop them, but what else can you do? No regulatory body cares, they don't care about staffing levels as they had in the distant past. I'm going to use my colleagues to complain (they are good at that) and I think that is the only way things will change, get the brigades of ER docs complaining about delayed or missing testing, etc.

Problems I've noted since my last post on the weekends: 1. Complaints from ER doc about the single med tech hanging up on them in frustration. 2. troponin turn around times 3 plus hours several times on ER and floor patients. 3. Poorly reviewed peripheral smears by the med tech. 4. FLU turn around times of 1.5 hours (usually takes 17 min for a 10 min POC test). 5. Have yet to see delayed QC/QA on clinical side but I am waiting for that to surface like I expect it to. I'm going to present these things again in a few weeks as I accumulate more findings and suggest changing course.

Curious, I saw the night weekend tech we are relying so heavily on in the elevator this very day and he is taking his clinical nursing rotations, so that's what his obvious long term plans are.

I appreciate the insights you offer. It is certainly curious environments we our lab community in these days.

 

[Torsed]

I sent another stern communication. They are going to allow two techs on the weekend nights now. The complaints from the ED docs helped. I highlighted errors and not using the call system.

Honestly, I think the only thing that swayed the staffing powers was the ED docs.

 

[y2k_free_radical]

I sent another stern communication. They are going to allow two techs on the weekend nights now. The complaints from the ED docs helped. I highlighted errors and not using the call system.

Honestly, I think the only thing that swayed the staffing powers was the ED docs.

U R CORRECT

 

[Spikebd]

I sent another stern communication. They are going to allow two techs on the weekend nights now. The complaints from the ED docs helped. I highlighted errors and not using the call system.

Honestly, I think the only thing that swayed the staffing powers was the ED docs.

Very interesting story. Sounds like a real headache

 

[LADoc00]

with one tech, you are literally a single multi-victim trauma incident from total and complete meltdown. I pray you are posting from Venezuela or Russia or someplace outside the U.S....

 

[wholeheartedly]

with one tech, you are literally a single multi-victim trauma incident from total and complete meltdown. I pray you are posting from Venezuela or Russia or someplace outside the U.S....

crap like this is happening all over in the US. corporate medicine and all.

 

[WEBB PINKERTON]

PAMA ain't making life any easier. It is catching many off guard. My guess is that LabCorp and quest are loving this as it will force more to sell to them.