LADHS Lab Handbook

The majority of test procedures performed in the Core Laboratory are available with a routine TAT of 4 hours. A limited menu of tests are available STAT with a 1-hour TAT. Median time for STAT Chemistry, Coagulation, Hematology with/without automated differential, and urinalysis should be 60 minutes or less from time ordered to time tests are resulted in Laboratory Computer.

• Core: 97039
• Micro: 97012
• Cytology: 91378
• Phlebotomy: 97040
• Blood bank: 97134

• M-F: 05:00, 10:00, 12:00, 14:00, 16:00, 19:00
• Nights: Unavailable after 19:00
• Weekends: 05:00, 10:00, 12:00

• Regardless of location: All urine labs: order ‘nurse collect’
• Often lab will hold samples for a few days, can call number below to add-on labs if sample still available
• Search by name for details pertaining to specific labs here: LAC+USC Lab Handbook

• ‘Lab collect’ venous draw labs unless urgent or phlebo not available (see hours above)
• Nurses often will refuse to collect labs when phlebo is available, but if it is extremely time-sensitive or will hasten discharge they are supposed to collect them - order as ‘stat collect’ or ‘timed routine’ and ‘nurse collect’ and CALL NURSE
• ABG ordered and drawn by MD, not RN

• RN can do ABG and labs but phlebo also goes to PCU
• If labs are routine and you don’t need them early then can order lab collect (RN will try and get you to do this)
• If you need labs in a timely manner in AM order RN collect, phlebo goes to PCU last

• Order all labs nurse collect, no phlebo in ICU
• ABG done by RN
• Generally labs are ordered for midnight

• QAM: Auto-populates either 00:00 or 04:00 and lab-collect, change it to 04:00 if pt on floor
• Routine: Will get collected at next phlebo lab collect
• Timed routine: will get collected at next phlebo

• Don’t place admit orders on patients in ED unless patient locations says “ED boarders” or they will get dropped when patient is admitted
• For labs you want collected in ED, they will auto-populate as ‘nurse collect’ in ‘ED boarders’ if patient is still in ED
  • If you REALLY want them stat order then stat and call the ED RN to expedite
• For AM labs that will ideally get collected the next day by phlebo on the floor, use the AM Labs tab, select QAM and change it from ‘nurse collect’ to ‘lab collect’ and change the location to ‘blank’, otherwise labs might not get drawn
• For AM labs section make sure there is a duration or the labs may fall off after 1 day
• Only order QDay AM labs you REALLY NEED
  • Don’t get a CBC w/diff if it won’t change management - it will also take longer

• Lab requisition forms (must be on County computer: Lab Requistion Forms)
• Quantiferon gold tests require a form to be filled out prior to lab being drawn
• Only order QDay AM labs you REALLY NEED
  • Will be in patient’s chart and you will get a call from RN about it
  • To expedite, fill out form and place in patient’s chart prior to ordering lab
• Urine toxicology: list of detected substances: Utox list of detected substances
• Recommended therapeutic drug sampling times: TDM Sampling Times

• Transfusion require coordination between MD, blood bank and RN, recent Type and Screen, and should be minimum number of units possible
• Step by step process:
  1. Ensure there is a type and cross order OR a recent type and cross (last 72 hours)
  2. Go to orchid subphase (Blood product transfusion >30 kg)
  3. Select the component “Request to blood bank” and the number of units which tells lab what to prepare
  4. Select order to “transfuse” the blood product which is the order for nursing to give the units
  5. Call RN and let them know that patient is pending a transfusion, the time frame which it should be given (ie stat) and whether or not the patient needs post transfusion labs
  6. Give the blood bank and few hours to type and cross and select a unit and prepare it and then call RN to ensure that it gets picked up and hung

• All studies must be ordered in Orchid
• Protocol Study: http://trojanimaging.com/CountyRadiologyRoomList.html
  • Regular weekday hours: 91583
  • Weekend 8am – 10 pm: 95838 (body imaging), 94149 (neurorads)
  • Overnight 10pm – 8 am (M-F), 8 pm – 8 am (weekend): 96688
• NPO Radiology:
  • Any imaging studies with contrast (at least 4 hours prior)
  • CT or Ultrasound guided imaging/procedures requiring NPO (at least 6 hours prior)
  • Abdominal Limited or Complete U/S
  • RUQ U/S
  • Trans-esophageal U/S
  • Renal, Hepatic, Lung guided biopsy (NOT needed for thyroid or lymph node biopsies)
  • Any procedure done under sedation (drains, biopsy, etc)
• Anticoagulation:
  • HOLD anticoagulation prior to IR procedures including drain placement/removal, liver/renal/lung biopsy
  • Order PT/INR
  • Ensure patient is consentable
• Checking on Procedure Timing
  • U/S Tech: 97207
  • Echo Tech: 97444
  • GI procedures: 95530
  • IR procedures: 94100
  • CT-guided: 97202
  • US-guided: 97207
  • EKG: 97466, 96705
• Ordering outpatient diagnostic testing
  • General: Ordering Outpatient Procedures
  • How to get post-discharge TTE within 1 week: Scheduling Outpatient Transthoracic Echocardiograms
• Delay in imaging
  • Delays in Stat or Urgent imaging due to lack of transport: call RN director Becky Sandoval if any transport issues x98841