Excuse Me??

  1. OK, who's heard of this one.

    I was taking care of a woman s/p ORIF of the hip. In ICU for cardiac monitoring (needs a new pacer generator). Hgb post-op = 9, which is down from 13 two days ago.

    The lab calls me and says that "Her Hgb is down significantly -- what did she have done?"

    I responded, "What's the value?"

    "I can't tell you that until you tell me what she had done."

    EXCUSE ME???

    This is an agency assignment. I've worked in several hospitals and never had lab refuse to give me a value; nor have I ever had them inquire as to my patient's condition. Aparently, this is fairly common at this hospital.

    I was not in a happy place (and in a bit of a hurry) so I simply told him and got the result.

    Thoughts?
    •  
  2. 45 Comments

  3. by   hoolahan
    Yes, write him up! That is inexcusable. This person sounds like a real control freak!

    BTW, you are leaving me in suspense here, what was the value???!!! Or, are you going to make me tell you something first!
  4. by   SharonH, RN
    I have never, ever heard of anything like that. Except for monitoring of PT/PTT, the lab has no need to know specifics of the patient's condition and it is only their responsibility to run the lab and report it. Period. There may be other exceptions but HGB/HCT is not one of them.
  5. by   KARRN3
    SPEAKING OF THE LAB, I HAD A CRASHING POST OP CABG,NO BP-SUSPECT HEMOTHORAX. I ORDERED STAT H/H WITH TYPE AND CROSS.AFTER 15 MINUTES-NO SIGN OF THE LAB, I CALLED THEM AND WAS TOLD THEY WERE BUSY AND WOULD BE UP WHEN THEY WERE READY. I REMINDED THEM THE MEANING OF STAT AND TOLD THEM IF I DIDN'T SEE SOMEONE IN THE NEXT THREE MINUTES I WAS COMING DOWN THERE.MY PATIENT ENDED UP 5/15 H/H A 2/L
    HEMOTHORAX AND A TRIP TO THE ICU AND THE LAB A VISIT FROM THE SURGEON.
  6. by   mtgirl63
    I don't deal with the lab much working in a nursing home, but I think that that lab tech was totally out of line --- they have no need to know what the patient had done, you on the other hand do need to know lab values!! I worked in a doctor's office for a while and a lab tech came storming into the doctor's office one day and tried to tell him what lab he could and couldn't order and even how to treat a particular patient. Now that was a big excuse me!!!! The doctor kindly reminded her that he was the doctor, not her, and that her job was only to do the lab that he ordered, not to tell him how to do his job. She got mouthy and he told her take her bone and go bury it!!!
  7. by   Mijourney
    Hi matts. Unless this is some strange form of a security measure for patient protection, if the lab needed to know more about the patient's condition, they could have simply come to the floor in person with the lab information and got the information from the patient's chart. Or, even better, whoever drew the blood should have gone to the chart when they were on the floor and got the information in the first place. Otherwise, as other posters have pointed out, the lab is not entitled to anymore information then what is needed for lab processing and results.
  8. by   hoolahan
    Yes, if the lab needed to know more, the diagnosis would have to be on the lab slip!

    The only time we have had to supply the lab with info is to get PRBC's, we need to fill in the H/H before they will release it, but they knew our surgeon was never a problem with abusing blood products, someone had to be below 7/21 before he would rx blood, unless they were super unstable and the bleeding was obvious, like pouring from CT's.
  9. by   RNPD
    Matt, this has happened to me a few times and I had the same reaction as you. One time, the lab called and asked if the patient was bleeding. Not that I was aware of, I replied, why? The H&H is very low compared to the last draw a week ago, so the patient must be bleeding. According to her, I needed to give her an answer before she would release the values. With a tone of voice as if speaking to an idiot, I carefully enumerated all the other reasons why a patient's H&H might be low-this patient happened to have had had surgery in between the 2 draws-and then stated that when i needed the lab's assistance to figure out WHY the lab values were out of limit I would ask for it. Until then, just report the values you have and I will decide on the correct intervention, if any. Never had a problem with that tech again.
  10. by   Cubby
    Does not sound like the "Lab Guy" knew anything of confidentiality issues eh?
  11. by   Agnus
    Originally posted by hoolahan
    Yes, if the lab needed to know more, the diagnosis would have to be on the lab slip!

    The only time we have had to supply the lab with info is to get PRBC's, we need to fill in the H/H before they will release it, but they knew our surgeon was never a problem with abusing blood products, someone had to be below 7/21 before he would rx blood, unless they were super unstable and the bleeding was obvious, like pouring from CT's.
    Abusing blood products!!!! What!!! I can not imagine this happening. Blood products are not perscribed a a whim. Since when is is that the physician can't make his own decisions now based on the individual patient needs? It's bad enoungh the insurance companies try to practice medicine but the lab now?
    If there is a sever shortage of blood he should be informed but this kind of rationing is rediculose. Even when blood must be legitimately rationed it needs to be the physician who make the final decision. Abusing indeed!!!!
  12. by   sandygator
    It's funny this has recently started at my hospital as well, Matt...not exactly the same way...but the lab calls with an H&H result and voices concern over an increased crit...um....we gave the patient packed cells, ok? *LOL*
  13. by   hoolahan
    Angus, I hear what yoou are saying, but believe me, every rule is created out of a need. Believe it or not, there was a surgeon who would prescibe blood products for pt's as volume, not necessarily b/c they were bleeding. This is post open heart. Now of course they would never have the nerve to say "No," to a doctor, but I guess they were documenting it. Also, I have seen blood products ordered on pt's who were DNR, clearly dying, and sometimes, in those situations, I feel it may be inappropriate to give blood, esp if the living will specifically states no blood products. If someone was ever hemorrhaging, the lab was authorized to release 2 units at a time, all we had to do was put the doc on the phone.


    But as far as releasing a lab value w/o knowing the diagnosis, there is never a reason for that, since the lab is NEVER going to have to react to the value, other than to recognize it's critical, and to know when to report it, or know when they maybe should run it again. They will not decide how much insulin to give, if PRBC's are needed, or how much coumadin to give. Maybe they do just need an invitation to read the chart. This needs to be reported so that the person can be addressed , and this behavior stopped. When you write up the incident report, double check that there is not a policy that requires you to release this info, and state that on the policy.
  14. by   WriteStuff
    Gross negligence if you ask me!!

    I would have asked to speak to the Lab Supervisor on duty at the time and request that the Lab's Policy that drives this kind of response, be read to me over the phone!

close