Those vials with the colored tops that couriers whisk from clinics and inpatient units to hospital-based laboratories or the Duke University Health System (DUHS) Clinical Laboratories core lab on Ben Franklin Boulevard in Durham hold not only the lifeblood of patients, but many of the secrets to their treatment. Take for example, the following story about clinical microbiology, published last year in LabLines, the newsletter for the laboratories:

“A spinal fluid specimen was received for culture on a 1-year-old who had been running a fever, vomiting and experienced a seizure. The doctors were concerned about meningitis. The patient had been started on ceftriaxone and vancomycin to cover for probable causative agents, Streptococcus pneumoniae and Hemophilus influenzae.

The gram stain, which is performed with each spinal fluid culture, showed the presence of gram positive rods â€" a very unexpected finding. The doctors immediately thought of Listeria, although this patient was theoretically too old for Listeria meningitis. The child’s antibiotic therapy was changed since ceftriaxone is ineffective against, and vancomycin is suboptimal, for Listeria. Two days later, the culture was identified as Listeria monocytogenes. By then, the child, on the new antibiotic therapy, was much improved.

In this case, not only did a specific lab test have an immediate and unexpected effect on the patient’s diagnosis and treatment, but also the test was a routine, simple one.

Vital Part of Health Care Team
A review of the process of lab work within DUHS shows just how many people are involved:

• Physicians order the testing.

• Health unit coordinators enter the orders into the computer.

• Nurses, physicians, phlebotomists or other staff collect the samples.

• Laboratory messengers deliver samples.

• Laboratory professionals analyze the sample. Today’s analysis incorporates automated, computer-assisted instrumentation, however, there are still many areas where direct, hands-on attention to patient specimens is essential.

• Information Technology staff support the computer systems into which laboratory results are entered. At DUHS, this includes the Meditech System at Duke Health Raleigh Hospital and the Cerner System at all other locations, the hospital information systems, and the tools for displaying results (CareVu, eBrowser or OAS GOLD).

• The Laboratory Client Services staff provides assistance and information about locating specimens or laboratory results 24 hours a day, seven days a week. The staff can be reached at 681-2545 or 613-8400.

Celebrating Success
Laboratory employees kicked off National Medical Laboratory Week by attending a Durham Bulls game on Sunday evening. They’ll continue the celebration with meals for laboratory employees at each of the health system’s three hospitals and at the Ben Franklin site, as well as with games and competitions within each individual laboratory (see sidebar for list).

“Duke can be extraordinarily proud of the faculty and employees who play such a vital role in promoting and protecting the health of our patients,� says Earl Buck, executive director of the DUHS Clinical Laboratories. “From our highly trained technologists and dedicated information technology staff, to the phlebotomists who collect and couriers who deliver the samples, to the managers and supervisors who keep the big picture in mind, the laboratory team is truly professional and does an outstanding job. Led by medical directors from our faculty, the laboratories provide a critical service that touches 95 percent of all patient interventions at Duke.�