I realized a few minutes ago when I took a break from all of the required writing I currently have to do, that it had been several days since I posted. So I’ve decided to give you a description of what I typically do any given day:
Arrive at the medical center between 6:30am-7:00am. It takes about 5 minutes to walk to my desk across the hall from the core lab from the street (big place). I have approximately 45 minutes to review the patient charts, lab results, and lab orders, for the patients in whatever unit I am currently assigned to round in – right now I am rounding in the MICU or Medical Intensive Care Unit which has 3 hallways of patients.
Rounding, for most areas, starts between 7:45am-8:00am although some areas start rounding at 4am and others do not start until 1pm, just depends on the area and the specialty. Rounding also takes anywhere from 2 – 5 hours to complete depending on the complexity of the patients, admits during rounding, or if there is a patient emergency during rounding (i.e. respiratory distress, code, etc). The patient care team comprises of the Attending physician, one or two fellows depending on the specialty, between two and five residents, an intern, a clinical pharmacist, and myself. Sometimes we will have a couple of medical students or pharmacy students as team members. Occasionally, and it is really dependent on the area and the acuity of the patient, the patient’s nurse, a respiratory therapist, a dietician, or case manager/discharge planner will also round with the patient care team but they are on a patient by patient basis.
I have had questions in regarding everything from:
- What is the transfusion ratio on a patient that received a hodge-podge of 82 different blood products during a massive transfusion protocol (they lived!)?
- What tests should be ordered to evaluate a rapidly climbing potassium result?
- Can old age cause positive double-stranded DNA (the patient was only 57 years old)?
- Why were no bands reported on the differential today but there were bands reported yesterday?
- How often should we measure a APTT for a patient that was switched to argatroban for heparin-induced thrombocytopenia?
- Plus many, many more …
After rounding I scarf down some food while responding to emails. Most emails relate to our Diagnostic Management Team. We receive a request for consultation and the various team members chime in until a consensus is made and then the recommendation is presented to the physician. About two thirds of the time I am the one who contacts the physician by both phone and then followed with an official email. As of today, since I started residency 8 weeks ago, the DMT has saved $50,761.80 in unnecessary testing.
At some point in the afternoon, between emails and phone calls, I also perform a utilization review for the previous 24 hours where I am looking for the commonly mis-ordered tests, which include but are not limited to: coagulation testing beyond PT, PTT, and Fibrinogen, hepatitis testing, “funky” immunology testing, etc. If they have already resulted then I contact the physician by phone and email notifying them that either it was the incorrect test, the timing of the test affected results, and solutions to the issue which include either the appropriate test to order or a when an appropriate time to order the test is for their patient. If the test has not already resulted, I cancel the test and contact the physician by phone and email explaining the reasoning for the cancellation as well as solutions as previously stated. This portion has only been in effect for the last three weeks (since the new residents arrived essentially) and this has saved an additional $5,350.30 in inappropriate testing.
The rest of the time, unfortunately, is spent doing lots … and I mean lots … of writing. The thesis project proposal itself is 30 pages of solid writing, which does not include the IRB submission forms, presentations every week and sometimes multiple presentations, journal of daily activities, documentation of all activities and patients seen in rounds.
Somewhere in this schedule I also attend Clinical Pathology / Anatomic Pathology Grand Rounds with the pathology residents as well as Infectious Disease Grand Rounds. I am scheduled to present in both in the near future. Grand Rounds are where all of the physicians (attendings, fellows, residents, and even sometimes med students) discuss interesting cases from the previous week and potentially change protocols relating to either diagnostic or treatment strategy. I may attend others in the future, but these are the two the I currently attend every week. I also assist the pathology residents in their clinical pathology quality improvement projects because none of them have any idea what to do in the non-anatomic pathology realm. No … seriously … they have no idea! So I help in developing and assigning the projects to the pathologist residents and then monitor their progress and help evaluate the finished project. There is a resident with a project every month so this never ends.
So this is pretty much a day in the life. The emails and phone calls do not stop when I leave as I still receive them at night. Healthcare does not have banker’s hours – it is a 24 hour / 7 days a week / 365 days a year job.
And, quite frankly, direct savings of over $56,112.10 in an 8 week period of time ain’t too shabby. 🙂
9 thoughts on “A Day in the Life of a DCLS”
Thanks for the post, Brandy!I have two questions-
1. Do you have answers to most questions during rounding or do you follow up with answers later in the day?
2. Do you think you will specialize in one subject matter after you finish your residency? Like answering Endocrinology questions regarding lab or just answering microbiology questions.
It depends on the day and the service I am rounding with as some are more needy than others 😉 . Some days I answer more questions in rounding, other days it is later in the day. I think I will stay as a generalist but I do envision a day that DCLS is specialized in the various areas. Thanks for the comment!
You are doing a great job, and I honestly can’t imagine how they would be managing all of this if you were not there. The cost savings over a year would equate to your salary….
I’ve enjoyed reading your posts. Where are the job opportunities for this new position and what is it called ? I can’t find them posted anywhere by searching for a DCLS requirement. Thanks.
Thank you for your comment. I will be the first graduate so there are not really any DCLS-specific positions advertised as of yet. I have had multiple positions offered for when I graduate, so there is a market for us.
That is amazing!
Thanks Brandy for sharing.
You do such an amazing work. The magnitude (relevance) of work you are doing, it’s just incredible! This residency/ consultation services should attract some sort of pay (increment). Do they? While I know it’s not just about the money, I’m eager to know whether remuneration is different from that of other lab managers/ MLS bc of the work you do. PS I’m a fan from outside the US, and have been ff developments with the DCLS. I congratulate your work and efforts, and must say I’m rethinking my decision to ‘branch out’ of traditional lab practice solely bc of your shared experiences on this blog. Keep the great work going!
Thanks brandy for sharing this info.
This is something I am interested in doing for a doctorate program. I am an MLS and I have worked in both reference lab and hospital lab. I have worked the bench in areas like endocrinology(immunoassay testing), chemistry ( running analyzers ), Microbiology( covering parasitology, mycology, virology, bacteriology), cytogenetics ( FISH, chromosome analysis and, microarray ), hematology, coagulation and, urinalysis.
I am currently a laboratory quality specialist.
I got my masters in Laboratory Medicine, and I am very interested in the DCLS program.
My only problem is that the program is not in my state which means I will have to do the program online and will be paying out of state tuition.
Since you are ahead of me in the game,do you have any advice to give to someone like me regarding Your experience with the program?
What you like/dislike about it ?
Pros/cons of the DCLS program?
What made you get in the program?
Also, which DCLS program would you recommend? Why?
Your piece of advice?
Thank you for the comment. Let me first say that I am a now a member of the NAACLS DRC committee over DCLS program accreditation and cannot recommend one program over another. There are 2 programs currently with students and a 3rd getting ready to admit their first class. The two established programs are Rutgers University and UTMB-Galveston; Kansas University Medical Center is the program about to enroll their first class. Each program is quite different, has different objectives, and different requirements. You should research them all, see which program aligns with you career goals, and then choose that one.