IMPLEMENTATION OF A SUCCESSFUL ON-CALL SYSTEM IN CLINICAL-CHEMISTRY

Successful practice of clinical pathology depends on a wide variety of laboratory, clinical, and managerial decisions. The skills needed to make these decisions can most effectively be learned by residents and fellows in pathology using a service-oriented on-call approach. We rep ort our experience implementing an on-call system in the clinical chem istry laboratory at the University of Louisville Hospital (Ky). We det ail the guidelines used to establish this system and the elements requ ired for its successful implementation. The system emphasizes a labora tory-initiated approach to linking laboratory results to patient care. From inception of the program during late 1990 through 1995, the numb er of beeper calls (including clinician contacts) steadily increased a nd is currently 8 to 20 per week. The on-call system is active 24 hour s per day, 7 days per week, thus representing activity on all three la boratory shifts. Types of responses were separated into administrative (12%), analytical (42%), clinical (63%), quality control or quality a ssurance (12%), and consultation (13%) categories. We also present 6 c ase reports as examples demonstrating multiple elements in these categ ories. In 23% of the calls, clinician contact was required and achieve d by the fellow or resident on call for the laboratory. The on-call re ports are documented and presented informally at weekly on-call report sessions. Emphasis is placed on learning and refinement of investigat ive skills needed to function as an effective laboratory director. Edu cational emphasis for the medical staff is in establishing awareness o f the presence of the laboratory as an important interactive component of patient care. In addition, we found this program to be beneficial to the hospital and to the department of pathology in fulfilling its c linical service and teaching missions. Our experience may be helpful t o other institutions establishing such a program.