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Scientific Workshops will be held on Sunday, June 2:

 

Sunday June 2 Morning Part 1 – 0800-0930

Sunday June 2 Morning Part 2 – 0930-1100

Sunday June 2 Afternoon Part 1 – 1300-1430

Sunday June 2 Afternoon Part 2 – 1430-1600

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W101 Improving Clinical Laboratory Quality and Efficiency Through High Performance Auto-Verification
Sunday June 2, 0800-0930

 

Edward Randell, Eastern Health Authority

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Describe how the auto-verification process is used to improve laboratory efficiency and add value.
  • Identify which factors have the greatest impact on auto-verification efficiency and describe how they can be safely adjusted toward greater efficiency.
  • Describe how auto-verification can be used to standardize laboratory test review and troubleshooting.
  • Begin design and construction of a customized, safe and high performance auto-verification program to improve laboratory efficiency and add value to local settings

Auto-verification is not only a tool to improve laboratory efficiency but also can be used to improve quality and safety. A safe and effective laboratory test auto-verification system requires considerable thought, planning, and customization to local laboratory practices and patient demographics. Auto-verification schemes are built on test specific rules designed to identify and select out for review test or sample characteristics requiring further intervention. High performance auto-verification schemes play a central role in laboratory quality assurance by going beyond the basic selection process, but focuses on maximizing efficiency of the test verification by reducing wasted effort and time, and improving effectiveness through error and non-conformance detection beyond that possible by manual review by experienced laboratorians alone. This session will discuss how to build a high performance auto-verification program from the ground up, including a presentation of test-specific rule sets, with open discussion of each component; and how rules are tested, validated, and monitored for effectiveness and continued process improvement.

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W102 All You Really Need to Know about Biotin
Sunday June 2, 0800-0930

 

Jessica Gifford, Calgary Laboratory Services

Hossein Sadrzadeh, Calgary Laboratory Services

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Describe the biochemistry, physiology, and dose-dependent pharmacokinetics of biotin.
  • Describe strategies to handle high biotin specimens.
  • Describe successful approaches to educate physicians, patients and laboratory personnel.

Biotin is a water soluble B-vitamin taken as an over-the-counter supplement to improve the cosmetic appearance of hair, skin, and nails; or prescribed as a treatment for inborn errors of metabolism and recently multiple sclerosis. Many commercial immunoassays employ the high affinity interaction between biotin and streptavidin, a protein purified from bacteria to measure different analytes. As such, these immunoassays are subject to interference from elevated levels of biotin in blood generating either false positive or false negative results. Biotin is a patient safety risk and a number of publications in 2018 shed light on the dose-dependent pharmacokinetics of biotin as well as pre-analytical strategies to remove this interferent. Furthermore, manufactures adopted new approaches to make their assays less susceptible to biotin. Despite this work, biotin continues to cause problems in immunoassay platforms. This workshop will describe the biochemistry, physiology, and simplified pharmacokinetics of biotin and teach all important aspects of biotin interference in clinical tests. In addition, the authors share their experience in 2018 of handling biotin issues at their own large laboratory. Most importantly, the strategies they took to educate all affected clients as well as laboratory personal, which resulted in no biotin-related incidents in the second part of 2018. This workshop is aimed at clinical biochemists, general pathologists, clinical biochemistry fellows, general pathology residents, and medical laboratory technologists.

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W111 Neuroimmunology for the Clinical Chemist
Sunday June 2, 0930-1100

 

Hans Frykman, UBC Neuroimmunology Lab and Neurocode Labs

Ross Sadler, Oxford University Hospitals NHS Foundation Trust

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Identify antibody driven neuroimmunological disorders and what tests are useful.
  • Communicate and potentially guide the clinician regarding neuroimmunological tests.
  • Evaluate different test platforms used and understand their own advantages and disadvantages with respect to turn around time, robustness, sensitivity and specificity.
  • Better tackle both underuse and overuse of these different neuroimmunological tests.
  • Understand when and why turn around time is of importance and how that might steer the choice of testing platform.
  • Have knowledge of treatments and how antibody testing influences them.

Clinical neuroimmunology is an area of rapid development in recent years. The clinical chemist is increasingly facing the responsibility to approve or decline these expensive and potentially important tests.

This course is giving an overview of the different neuroimmunological disorders and which antibody is useful in which disorder. It will further dwell on different testing platforms and the advantages and disadvantages in terms of turn around time, robustness, sensitivity, and specificity.

This course will also discuss how to tackle both overuse and underuse thereby going into more detail on the specific relative importance of each antibody in finding the right diagnosis.

Finally, treatments will be reviewed in the context of how antibody testing governs them.

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W112 Emerging Trends in Mass Spectrometry: Hematology, Endocrinology and Point Of Care
Sunday June 2, 0930-1100

 

Jessica Boyd, Calgary Laboratory Services

Hossein Sadrzadeh, Calgary Laboratory Services

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Discuss comfortably how mass spectrometry works.
  • Compare the strengths and weaknesses of different types of mass spectrometry.
  • Discuss and understand the role of mass spectrometry in all clinical labs.

Over the past 30 years, mass spectrometry (MS) has become a fixture in clinical toxicology laboratories due to its high sensitivity and selectivity for detection of drugs and in microbiology laboratories for bacterial identification. Until recently, the high initial instrument cost, sophistication of the instrument and software, manual method development, relative lack of vendor supported automation solutions and long turnaround time have kept MS applications from being used in other areas of the clinical laboratory. That is beginning to change, with MS poised to make the transition to a routine testing platform for endocrinology, hematology and even point of care testing.

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W201 Getting the Most out of EP Evaluator – Digitizing your Data Transfer and Report Generation
Sunday June 2, 1300-1430

 

Dana Bailey, Dynacare

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Learn various ways to upload data into EP Evaluator (manual entry, rapid results entry, copy-and-paste, and ODBC).
  • Learn how to set Master Policies in EP Evaluator for your laboratory.
  • Learn how to generate Composite validation reports and save digital files of your validation documents.

Does your institute have an EP Evaluator license or are thinking of purchasing one? Are your staff still manually keying in data and printing paper validation reports? Want to learn how to transfer your data electronically and manage your validation reports as digital PDFs? In this hands-on workshop, we will review the end-to-end capabilities of EP Evaluator for data import, experiment generation, and report generation. Through this process, we will explore various data-upload options for EP Evaluator, including .csv upload direct from automated instruments. We will also look at creating PDF reports for digital archiving. The first half of the session will consist of a lecture and the second half will provide attendees with an opportunity to work with demo datasets. Attendees will be provided with demo data and will be expected to bring a laptop with a working version of EP Evaluator.

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W202 Defining Quality Assurance Standards for POCT for Glucose Meters
Sunday June 2, 1300-1430

 

Allison Venner, University of Calgary; Alberta Public Laboratories

Paul Yip, University of Toronto; Sunnybrook Health Sciences Centre

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • State the current IFCC recommendations for the evaluation of glucose meters for critical care.
  • Describe the limitations of glucose meter accuracy when used in critically ill patients.
  • Define a QA program for the initial and ongoing validation of glucose meter performance.
  • Identify strategies for the end-user to use when they act on glucose meter results that are considered critical.

This will be an interactive workshop for those with interest in POCT. Glucose meters have become an essential tool for glycemic control in diverse patient populations. While technology has improved the user experience and data management with these devices, analytical concerns remain especially when testing is performed on critically ill patients. Since clinicians are focused on patient care, their time to identify or troubleshoot problems while using the meter poses a challenge that can impact the accuracy of results. In organizations that practice POCT, glucose meter results are often clinically treated like a laboratory result despite the potential for error due to operator technique, patient status, or the glucose measurement system itself. However, laboratory professionals with responsibility for quality assurance (QA) oversight for POCT often must decide for themselves the initial and ongoing validation of analytical performance of the meter. Environmental scans have revealed significant variation in QA practices that should be addressed by a consensus of best practices for the assessment of POCT glucose meters. For this workshop, participants will be asked to contribute their perspectives and experiences with glucose meters in the institutional setting. This will include criteria for glucose meter validation, directives for users when critical results arise, and contraindications to the use of glucose meters on patients.

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W221 Making MU More Meaningful for You: Understanding and Applying the New ISO Measurement Uncertainty Standard TS20914
Sunday June 2, 1430-1600

 

Isolde Seiden Long, University of Calgary; Alberta Public Laboratories

Allison Venner, University of Calgary; Alberta Public Laboratories

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Compare the approach for calculating MU as described in TS 20914 with other approaches.
  • Understand practical methods for performing MU calculations that can be used in their own laboratories.
  • Describe clinical scenarios where MU can aid in the interpretation of patient test results.

Measurement imprecision is inherent to all results in the clinical laboratory. The calculation of measurement uncertainty (MU) recognizes that a single measurement result is actually a member of a possible distribution or dispersion of laboratory results. This concept has important implications in the interpretation of medical decision limits and reference change values in clinical medicine, however it is often overlooked in day to day clinical practice.

Determining MU for each measured analyte is an accreditation requirement for many medical laboratories in Canada. This requirement is derived from ISO 15189:2012, subclause 5.5.1.4, and it applies to any lab accredited to ISO 15189. The definition of MU acknowledges that the interpretation of the outcome from the calculations for MU is highly dependent on the input parameters. Different laboratories include different contributions of uncertainty in their calculations, as there has been no international consensus document available to provide guidance specifying which elements of uncertainty to include in the calculations.

In 2019, a new guidance document published by ISO TC 212 will bridge this gap TS 20914, “Medical laboratories—Practical guide for the estimation of measurement uncertainty”. This workshop aims to provide an overview of this document and why it is important to the clinical laboratory. The presenters will discuss practical examples for determining MU using the principles presented in TS20914, and describe the benefits of using MU information on a day to day basis in the clinical laboratory.

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W222 Implementation of Test Utilization Initiatives to Improve Quality of Patient Care
Sunday June 2, 1430-1600

 

Daniel Beriault, St Michael’s Hospital

Maria Pasic, St. Joseph’s Health Centre

Jennifer Taher, University of Toronto

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Understand the process of scorecard design, data collection, and distribution to practitioners in order to provide the most relevant information on their ordering practices.
  • Learn how to successfully implement a reflex or hard-stop algorithm in a hospital system, and to gain specific examples of utilization projects that your institution may benefit from.
  • Discuss the role of physician engagement with the laboratory for developing test utilization strategies.

In this workshop, we will present approaches for implementing various test utilization initiatives and will highlight the successful projects at Unity Health Toronto targeted at improving quality of care for our patients.

The first part of the workshop will focus on how to implement an ‘audit and feedback’ process for healthcare practitioners, including recruitment of an interprofessional team, design and distribution of scorecards, and clinician education. We will also describe the benefits of developing a streamlined approach to the data collection and scorecard development. At the St. Joseph’s Health Centre site, a team of healthcare practitioners, laboratory professionals, informatics specialists, and a medical education researcher comprise the Best Practices in Medicine team (BPiM). At regular intervals, this team provides personalized scorecards outlining the usage of various laboratory tests to practitioners within the Department of Medicine and also offers optional self-reflective online educational activities (practice guideline-based and case study-based). Computerizing the data collection and analysis steps has allowed BPiM to regularly deliver detailed scorecards to 13 different medical specialties within the Health Centre, with a plan to expand further to other large academic institutions.

The second part of the workshop will focus on the development of one and two-tiered reflex algorithms and implementation of hard stops. At the St. Michael’s Hospital site, the laboratory utilization committee has implemented test reflex and hard-stop algorithms into the laboratory information system to improve test utilization and patient care. A wide range of chemistry tests have been strategically considered and algorithms implemented through collaboration with expert physicians. Reflex strategies that will be discussed include thyroid function, celiac screening, bilirubin testing, and anemia. Hard-stop algorithms that will be discussed include hemoglobin A1C, serum free light chains, and protein electrophoresis. Proper implementation of these strategies requires strong clinical engagement, data analysis, and generally involves multiple Plan-Do-Study-Act (PDSA) cycles to ensure optimal performance.

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