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Recent Artery Conversations

Free T4

We recently established new reference intervals for our Roche free T4 assay based on evaluation of an apparently healthy population. Upper limit is now 1.7. A subset of endocrinologists is unhappy with this change because they are seeing an increased number of stable hormone-replaced patients with normal TSH and mildly elevated FT4. While I believe that there is scientific rationale for why this may occur in LT4 treated patients, this rationale isn't relieving the concerns of the clinicians. They have expressed that they have high-maintenance patients who become overly concerned when their labs are not in the normal range. So my question is two-fold: 1) any Roche customers who determined the need to expand the upper ref limit? and 2) how are you dealing with clinicians and patients who increasingly struggle in the "MyChart era" with unexpected lab results? I feel like I'm frequently asked to make ref interval changes to make these problems disappear.
Please share.

Rubella IgG: Qualitative vs. Quantitative

Our lab currently offers a quantitative rubella IgG (Roche) orderable for patients when quantitative antibody levels are requested by outside institutions for documentation of immunity status for students, employees, etc. However, when looking at other institutions most only report the test in a semi-quantitative way. We are currently thinking of changing our methodology and are wondering if having a quantitative rubella IgG orderable is really necessary. How does your lab handle requests for quantitative results for rubella IgG? 1. Do you preform a quantitative rubella IgG assay? 2. Do you preform a semi-quantitative rubella IgG assay and report out the qualitative interpretation plus the numeric AI (antibody index)? 3. Do you preform a semi-quantitative rubella IgG assay and report out the numeric AI (antibody index) in the comment section of the lab result upon request?
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Increased Phone Calls

Our hospital laboratory is being crushed by telephone calls from nursing staff looking for the status of SARS-CoV-2 tests. I am working through nurse leadership to reduce the phone calls, but I'm wondering if other labs have encountered the same problem and what you did to fix it. Did you use an automated phone message? More staff to [the] handle phone calls?
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