Coagulation Rotation

Goals and Objectives

During this rotation, the resident will demonstrate the following competencies:

Patient Care

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Work with healthcare professionals, including those from other disciplines, to provide patient-focused care
Observe patient counseling/clinic sessions/ history and physical examinations at the pediatric hematology clinic.
Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families in pediatric hematology clinic
Gather essential and accurate information about patients
Synthesize and present cases seen in clinic to pathology attending with a focus on relevant coagulation clinicopathologic findings
Provide prompt consultative support for patients with bleeding and thrombotic disorders.
Use information technology to support patient care
Preview cases, synthesize clinical and laboratory findings, obtain histories and review results to render a diagnostic interpretation
Demonstrate an investigatory and analytic thinking approach to clinical situations
Answer questions from clinicians about coagulation testing with attending approval and review prior to answering questions (graded responsibility)
Review data on implementation of new hemostasis assays
Be involved in interpretive pathologist reviews of cases
Know and apply the basic and clinically supportive sciences which are appropriate to their discipline including molecular biochemistry of the hemostatic system, relevant findings in the patient history, congenital and acquired coagulation disorders, diagnostic test strategies
Demonstrate knowledge of:
- algorithmic strategies to coagulation testing
- manual and automated methods used to perform routine and specialty coagulation laboratory testing the limitations and interferences for such tests
- application and interpretation of platelet function testing and mixing studies
- differential diagnosis, evaluation, and management of bleeding disorders and for thrombophilia
- pathophysiology of normal hemostasis and for hemostatic disorders
- diagnosis and management of disseminated intravascular coagulation
- impact of phlebotomy and sample collection on coagulation testing
Assess technical performance of routine and specialty coagulation assays
Participate in routine and specialty coagulation testing assay sign-out and generate written interpretations of test results with communication to ordering physicians as applicable
Prepare a 10-15 minute presentation to coagulation technologists on a coagulation testing topic
Pass 3 quizzes and 1 final examination
Complete reading of routine and specialty coagulation test procedures

Practice-Based Learning and Improvement

Analyze practice experience and perform practice-based improvement activities using a systematic methodology
Participate in current coagulation laboratory operations and assist with projects such as: method validation, new assays implementation, normal range studies, laboratory assay trouble-shooting, quality assurance, procedure review
Review daily quality control results for specialty assays and specialty coagulation laboratory pending list for specialty assays at the start and end of each day
Obtain previous laboratory test results from LIS and clinical data from HIS
Interface and interact with ordering physicians to determine the reason for the test order and the information sought by the clinicians
Review specialty testing for inappropriate test order entry patterns and communicate findings to attending pathologist and/or ordering physician as appropriate
Use information technology to manage information, access on-line medical information; and support his/her education
Interpret coagulation and special coagulation test results
Perform clinical correlation and assess appropriateness of coagulation testing based on clinical correlations
Correlation of abnormal coagulation results with hematology and chemistry assays
Facilitate the learning of students and other healthcare professionals
Demonstrate mastery of didactic case studies

Interpersonal and Communication Skills

Use effective listening skills and elicit and provide information using effective verbal and nonverbal, explanatory, questioning, and writing skills
Communicate with laboratory technologists about test methods, additional test requests, etc.
Communicate with attending pathologists about patient results
Work effectively with others as a member or leader of a healthcare team or other professional group
Present clinical cases at laboratory sessions or clinical conferences as appropriate
Interact appropriately with technical staff in coagulation laboratories
Present lecture to technical staff at the end of the rotation
Communication of test results to clinicians
Communication with clinicians to obtain history for interpretation of test results and/or appropriateness of tests ordered.
Presentation of journal articles about coagulation topics at Journal Club if scheduled

Professionalism

Demonstrate respect, compassion, and integrity with patients and accountability to the profession by observation of patient evaluations in Pediatric Hematology Clinic and presenting findings to pathology attending
Demonstrate a commitment to excellence and on-going professional development by attendance at all didactic sessions, conferences, and bench sessions with technologists
Being punctual
Being available and visible in coagulation laboratory area as required
Answering pages promptly
Conveying information to laboratory staff in a timely manner
Reading independently on topics related to patient case material and search primary sources
Demonstrating self-motivation and organization in pursuit of coagulation rotation requirements (reading and clinical service time)
Demonstrating courteous and collegial behavior with laboratory staff (laboratory supervisor will evaluate resident based on input from laboratory personnel)
Following up on all assigned coagulation cases until the case is completely signed-out with the Attending pathologist

System-Based Practice

Understand the fundamentals of laboratory accreditation and regulatory requirements and how the College of American Pathologists Laboratory Accreditation Program affects the healthcare organization, and their own practice by:
Review recent CAP proficiency testing programs results for coagulation for UHC
Performing a "mock" CAP inspection of the coagulation laboratories
Preparation of a report of the "mock" inspection findings
Presentation of the "mock" inspection findings and report to the coagulation supervisor and pathology attending
Practice cost-effective healthcare and resource allocation that does not compromise quality of care by
Having a working knowledge of and familiarity with the Laboratory Information System (LIS) and entry/retrieval of laboratory results and familiarity with Hospital Information System (HIS) for retrieval of clinical information on patients
Generating via the LIS on daily basis a list of special coagulation tests ordered ("Queue") and then reviewing each case for appropriateness of specialty coagulation tests ordered. After discussion with the pathology attending, with approval of the pathology attending the pathology resident may contact the ordering physician to discuss the tests ordered and if tests are recommended
Understanding the steps in specimen handling and processing through the triage department and the criteria for sample rejection (observation and procedure review)
Designing a change control packet for a mock new test including elements required for bringing up a new test
Understanding cost-effective laboratory evaluation of coagulation disorders.

Duration

The Coagulation rotation is a one-month (4 week) rotation taught in one 4 week block.

Duties and Responsibilities

Review all procedures in coagulation and special coagulation laboratories
Arrange and attend bench instruction with the coagulation technical coordinator for bench time & observation of each of the routine and special coagulation tests performed
Daily review of Quality Control results for special coagulation assays
Attendance at monthly Quality Control review meeting
Daily preparation, review and sign out of "Review queue" special coagulation cases with the Attending Pathologist.
Coordinating a mutually convenient sign-out time with pathology attending on coagulation
Answering questions/following up cases for Specialty Coagulation Assays
Reviewing pending coagulation folder and review queue in morning and afternoon daily
Calling clinicians and or chart review to obtain additional information when necessary with attending approval
Complete special coagulation form for each patient case with written preliminary diagnosis on each form prior to attending review
Preview cases and complete path interpretation in LIS prior to attending sign-out
Entering review queue diagnosis/billing codes into LIS after sign-out
Evaluation of "ST AT" requests for specialty coagulation testing.
Attendance at clinical pathology conferences, hematology conference, laboratory rounds
Discuss with Hematology fellow before weekly Hematology conference re: cases that will be presented and review results prior to conference with attending
Participation in current coagulation laboratory operations and assistance with projects such as: method validation, implementation of new assays, normal range studies, laboratory assay trouble-shooting, quality assurance, procedure review
Coordinate with pediatric hematology clinical service observation of patient evaluations in hematology clinic
Preparation of 30 minute presentation to laboratory technologists on coagulation topic- for all three shifts

Teaching Staff

Katharine A. Downes, M.D., Rotation Director
Robert Maitta, MD, PhD
Hollie Reeves, DO
Lan Zhou, MD, PhD
Xiangrong (Eric) He, MD
Sanjay Ahuja, MD
Molly Klima, MT (ASCP) Technical Coordinator

Supervision and Evaluation

Faculty attendings supervise all aspects of the Coagulation rotation. The pathologist with significant resident contact during the rotation evaluates the rotating residents addressing the above six competency areas. Evaluations are based on daily interaction with residents and "sign-out" activities. In this way, residents receive daily feedback on their interpretations of case material. Residents are assisted by attending staff in preparation of coagulation presentations for laboratory rounds and for the technical staff and receive feedback on their presentations. Residents are evaluated on a monthly basis with regard to competency areas. Evaluations are reviewed with the resident and then forwarded to the Residency Program Director, where they are available for review.