Exploring the Lab's Vital Role in Healthcare

- This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals and students. I'm your host, Justin Kreuter, a transfusion medicine pathologist and assistant professor of Laboratory Medicine and Pathology at Mayo Clinic. Today we're rounding with Dr. Chancey Christenson transfusion medicine pathologist in the Department of Laboratory Medicine and Pathology at Mayo Clinic in Florida. Thanks for joining us today, Dr. Christenson. - Well, thank you so much for having me.

I, this is really exciting. I'm really looking forward to talking you about all of this, - So, absolutely. And also, I guess we should say that this is the Lab Week episode, so we're really privileged to have you leading the charge on Lab Week and having this released. And encourage the listeners as you listen to this podcast, please share with your communities. So, Dr. Christenson, let's kick things off with, you know,

since this is a Lab Week episode, just maybe from your perspective, why is it important to highlight the extensive presence of the laboratory in current medical practice? - Thanks for that question, Dr. Kreuter. You know, I think there's a, a bunch of different groups that would be, that really need to understand the importance of the lab.

You know, I think just as a general overview, I think it's, I'm sure your audience is well aware of this, is that the lab does more than just run a test and analyze it, right? It helps, you know, pick the, select the tests that are appropriate. It helps pick the panels. It curates its own test catalog to get rid of apps today tests. It provides accurate and quality results.

It manages how they're ordered and even sort of manages access so that it's not just the first year resident or the most expensive test as well. So more generally, I think it's important to have that. I think for, it's important for the staff to know how important they're, you know, they're, they're really highly trained.

They have really specific set of skills and I think that sometimes the lab, because we're not directly patient facing, we're not recognized, but I think it's really key to highlight, you know, their hard work and really they're the driving force along the hospital as well. For patients, I think it's important to really highlight providing accurate and timely results. You know, I think that so many medical decisions get made based on clinic, on laboratory results.

And so I think for patients having that timely result, you know, I always think about if I had a family member that they went to a doctor, they, they found a lump, right? And that say a three day weekend happens, you know, they're sitting there and stewing that the whole time. So it's really part of the, the laboratory's job is to try to provide accurate time and results. And if it's bad news, you wanna try and sort of say, what does this mean? Here's some basic guidelines more than just Dr.

TikTok, you know? So I think those are important as well. I think in terms of clinical aspects, I think that, you know, this is from, is from Mayo itself, but 70% of the electronic health record is made of lab data. And obviously I think that number has probably changed based on radiology. And maybe it's increased because we have genotyping, but there's a lot of value and critical decisions really are made based on that.

You know, if you talk about a tropo, a third troponin level versus a second troponin level that determines whether you get access to whether you're admitted or whether you're discharged, you know, or whether even though it doesn't take very much volume, the top line diagnosis of a pathology report can certainly, certainly impact the treatment level as well. So, and finally, you know, the big boss, we gotta talk about administration, right?

They really need to know why it's important, you know, because so much of the time that they'll, they look at the lab and say, oh, it's just cost because it's not directly patient facing. And I think it's really important for us to sort of work to highlight our value, right? It's not just that the volume is 70%, it's that value over volume, right? And so the lab, the usual statistic is it's 3% of the total cost of a hospital.

So even if the, if the administration says cut your budget by 50%, we're saving one and a half cents per dollar. You know, that's not very much to talk about. But if you talk about something like a patient blood management program where you've avoided to, you've avoided giving patients transfusion studies should have shown that you can have a reduction in length of stay by up to three days.

So if you start saying three days discharge sooner, that's what the administration starts sitting up and start taking notice. And so all of that is really a more holistic approach towards what is the value of medicine, right? It's not the surgeon saying, well, we should decide transfuse or not. It's really the dedicated transfusion medicine doctor saying, well, here's the evidence that supports, when do you transfuse? Why are transfusing maybe blood?

They don't need to be transfused. So, - Oh, I love how, in your answer there, you start off with highlighting and outlining really the professionalism of the laboratorian, right?

So that, you know, our listeners during lab week now can kind of take stock of, you know, recognizing what are all these elements of the work that they do in terms of curating, making sure things are appropriate, making sure things are accurate, timely, that professionalism is just an awesome way to highlight right out the gate.

And then I also love how you're highlighting how we're not patient facing in, in most situations and so can be taken for granted, but that you're highlighting, right, with your story of if you had a family member with a lump, you know, very,

very quickly you realize that having the laboratory present with answers really matters a lot. So I, I think it, it highlights this, this importance that, that we're celebrating here with lab week. Now, you know, a lot of us right, didn't come out and were born into a world where we understood laboratory medicine. And certainly stories are always fun to recount.

And I'm kind of curious for, you know, what's your story when you kind of first became aware and really appreciated kind of this extensive role of the medical laboratory? - So when I was a medical student where I worked, we had paper charts. And so I remember there's a lot of delays in trying to find the chart you're trying to run around.

And then also, I remember when we were rounding, you always, as a medical student especially, you had to go and you, you had to write your wishbone and you had to like print out your sheets of paper. And so it's quite a labor intensive process. And then I also saw how, you know, critical decisions are really made based on that, you know, when patients, are they gonna be able, eligible to discharge while waiting on the labs? You know, are, are they, is their care need to be changed?

Do they need to go to higher level care? All that really depends on and critical points were really made trying to waiting for these labs.

And so I really saw the benefit of as well, and the impact was having the patient care and sort of as a more systemic approach what I was working on a QI project for, you know, the troponin levels about, you know, getting rid of the third one and you know, working with the emergency room versus the pathology and really just focusing on the impact of this is for patient safety and for patient care, but also you're talking about getting people out the door eight hours or even a day earlier.

And that really is impactful,

but for the patients not having to be in the ED, but also getting more people in beds, helping things out. So really I was just, it was incredible to watch the, how much just that single lab result alone could have all these downstream effects. It's like I'm really interested in the idea of labs and how do we make them better and how do we improve them and how do we, you know, what is our role as a pathologist? - Yeah. Yeah. I really appreciate that. You know, that leads into my next question.

So you're talking about kind of working with a team there to, to improve things. I'm curious if you could share how do you and your team work together for efficient patient care? - Sure. Well, I would just like to stress also as another transfusion medicine doctor, I'm sure you know, but you really can't have a hospital if you don't have blood, right?

So if you don't have blood in a hospital, you don't have an ER, you don't have an OR, or you don't have an ICU, you really don't have anything that you would think of as a hospital. You have like a, a minimally invasive outpatient clinic. And so I really try, same - Thing, that same thing could be said for chemistry, hematology, micro. So just wanna say we are very inclusive on this podcast, especially during lab week, - Right? I did not mean to disparage those other ones.

I just, my own field is you can't really run a hospital if you don't have a lab. And I think that it's, so I try and stress to my team all the time about that. I try and meet with them at least a couple times a week. I try, we have constant communication between the administrative aspects and the, or the supervisory aspects as well. So we're basically daily contact.

I really try and let my team feel like they're heard and really feel like they are, have the ability to express themselves and you know, they're able to have, you know, voice their concerns as well. So we have a weekly huddle as well. And then really at the end of it, we really try and tie back. So we recognize when people do a good job, if it's a good catch, or even if they have cases where what they have done has directly impacted patient care.

So just as a great example, we had a recent case where we had a really expanded buffy code. And so one of the blood bank technologists came to me and said, I think this patient may need leukapheresis. So I was on my way to go call the hematology service and they called me and said, oh, we have this patient that needs leukapheresis.

I was like, just by being able to see it in a tube, this blood bank technologist really was able to catch something at the same time that the hematologist, it was basically the same time the lab results resulted was they had come to us. And so it was really, I try and bring up instances like what they have done in the lab really has directly impacted patient care.

- Yeah, absolutely. And I could see that story totally going another way, you know, if somebody is in the ED and you know, somebody's not making the connection of needing leukapheresis, I mean, in this particular case, your story, this was redundancy, which is great, but I don't want anybody to hear that story and say, oh, hematology was calling anyway, right? So no, it highlights that value. And I, I really dig that.

So when I hear you talking, I hear you talking about really cultivating safe spaces. Maybe that is a little bit too much buzzworthy these days to talk about, but certainly I understand the value

of your team being able to talk. 'cause that's how you're able to really leverage their professionalism and what they can bring to the table. I, I imagine, and maybe I'm assuming too much, that when you came into this position, you had to work at creating that environment that maybe there were some setbacks. I'm curious, do you have any kind of thoughts, advice for how to kind of move through setbacks in creating that environment where people feel empowered to speak?

- I do think that there was certainly some aspects of the culture where they felt maybe a little bit afraid to that what they said was gonna be, you know, used punitively or that, you know, it made people afraid to speak and it really made them sort of a afraid to highlight problems. And then, you know, you and I, I really tried to encourage and talk to them about, you know, I'm really trying to listen. I'm not trying to punish you.

I'm really just trying to know if there's a problem in your workflow. It's really up to me as the leadership and as the director to try and get rid of that as well. And so I really tried to, you know, reassure them that we're not, we're not looking for problems just for problems. We're not looking for problems to punish people. We're really just trying to say what's, what is the actual problem and how can we fix it as well?

And so I think it took a couple of false starts of just constant reassurance that we are, in fact, you know, the leadership is really here for the staff to help make sure that their work environment is good and they feel supported and they feel empowered to make their decisions. But I think that we have a good settlement now, and I think people feel a lot more comfortable saying, you know, the leadership is listening and they're responsive to our needs.

- So for our audience to know, I mean, I, I really wanted to get Dr. Christenson for this special lab week episode specifically because I, I feel like you're such a driver. In fact, you're probably one of my colleague that I'm most interacting with who's always pushing the practice forward and always asking critical questions.

And so I'm a little curious what you're gonna say to this next last question that I wanna ask you is, how do you see the role of laboratory evolving in the coming years, I think the laboratory is gonna have a lot of importance in the coming years. You know, I think that there's a lot of evolving technology and I think there's a lot of things that are really coming up that'll be really exciting.

So I think one of the big ones is I think CRISPR and gene therapy, you know, I think it's coming in a big way. I know that's specific to our field, but it's, you know, the study of it is gonna be a big field if you just sort of talk about genomics and then proteomics in general, that's gonna be a gigantic field. I mean, I know precision medicine has sort of went through a lot of hype and then it sort of has faded away.

But I think that the new tests and the new assays are really good about talking about not just effectiveness of not just targeted therapies like CAR T and you know, different monoclonals, but specific things like talking about like vaccine inverse vaccines for autoimmunity. Or if you're talking about things like even, you know, drug genotyping, right? So they're saying even 40% of statins don't work for the population, let alone three quarters of the cancer drugs don't work, right?

So being able to provide targeted therapy quicker instead of having to sort of these trial and error is gonna be a big realm, I think as more and more assays of what is the genomics, what are the markers mean? What are the proteomics and how that field is gonna expand. I gonna be a lot of realm for pathology to play a role. I started to think another one that's really important is I think that there's a lot more at home testing and a lot home more POC testing.

So just if you think about send out kits, you're talking about cholesterol hem, A1C thyroid panel, vitamins, hormones, allergies, sexually transmitted diseases, fertility panels, tests like Cologuard. I think that's gonna rise more and more. And I think we're just keep discovering more and more biomarkers.

So being able to have the convenience of working at home, take the test, send it in in two or three days, get your results back as opposed to take time off work, go get your labs drawn, do all that, get it back and then have someone call you is gonna be a big realm for them as well as well, there's gonna be things like home-based at-home monitoring. So right now we already have anticoagulation like home INR monitoring and then obviously things like CGMs, right?

So the wearable and all of that is how does that integrate into smart devices? And, and when you have smart device, how do we interpret that, right? So our role is really gonna be working on those and how do we keep ourselves visible? How do we maintain, you know, working the space and say, what does that mean? Oh, you have a glucose of 6,000 from your home monitoring, you know, what does that mean? As opposed to like, what's, what's your regular test as well?

So I think we have a really important role in terms of the evolving wearables and smart technology. I find sort of, I think a really important role is that, as I mentioned before, I think it's important for us to sort of provide answers of what the tests are and what they mean. Because I think a lot of people do get their information from like Dr. Reddit. And so I think, you know, if you get a test result, you should sort of have reliance on what it is.

And it's really up to the realm of pathology. Our clinical colleagues are so busy and so overworked that, you know, if they get a an array of tests, it's hard for 'em to sort of explain what is, I think we have a good role and we can use things like AI technology or Dolly or things like Sora to sort of even make in-home videos, right? So here's your tailored, what is your elevated glucose, what does it mean to, for diabetes, what is a high thyroid panel as well?

So not just a couple sheets of, you know, just a paragraph or here's a sheet of paper at discharge, but literally like, here's your tailored avatar that explains what did these results mean to you as well. And sort of finally, you know, within our own field, I think there's a couple ones I think will coming up. I think that the lab was super important, as you may have or may not have noticed, there was a little bit of a bug going around in 2020 and 2021 and 2022 in 2023.

And actually there was, since the start of the 21st century, there's been sars, mers, Ebola, Zika and Covid. And I'm sure I'm missing a couple others. So there will always be newly rying diseases. You know, even in our own field we're talking about convalescent plasma. So having new diseases in a warming climate and then the ability to rapidly develop tests was a key part of our covid response.

But also convalescent plasma will be arising just as a method to treat whatever novel diseases they arise and sort of as the far futures, or not as the far future. But the, a little more sci-fi one than I would think of is, you know, with our own field, I think some of the inventions we're talking about is universal blood substitute.

We're talking about RBC pathogen inactivation, and I think even, it's a little bit hooky dokey right now, but I think talking about things like deriving youthful factors for blood, right? So there's already young plasma for Alzheimer's treatment. I think whatever the case of that, I think we will refine whatever that is and have an actual targeted treatment for diseases of aging as well.

And sort of just within our own work, I think the evolving role of the laboratory is how do we develop and implement and then validate different algorithms, right? So we can improve our own workflow, improve our own efficiency, and sort of just help ourselves in our own job as well. - That was the perfect lab week answer to that question of how is the lab evolving, right? The lab is everything is the theme of this year's lab week. And you started off your answer talking about really like

new technology and how that's gonna be driving stuff. You then were talking about how the lab is gonna be playing an increased role in therapeutics and then even, you know, the stuff that probably people aren't as, you know, enamored by but are, are certainly our patients really care about is sort of at home or the way that they can get this testing. How can we make it easier? And of course it makes my heart go pitter-patter to hear about really being able to explain meaning to a patient.

Yeah. So I, I think huge. Thanks for routing with us, Dr. Christenson, take thanks for taking the time with us today. - Yeah, definitely. Thank you for having me. It was great talking with you. - And thanks all our listeners. Thank you for joining us today. We invite you to share your thoughts and suggestions via email. Please direct any suggestions to MCL [email protected] and reference this podcast.

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