The Hidden Power of the Lab in Patient Care

Our guest, Dr. LaShanta Brice, embodies that journey. Dr. Brice earned her doctorate in clinical laboratory science from the University of Texas Medical Branch at Galveston in 2021, building on a master's in medical laboratory science from the University of South Mississippi, and a Bachelor's from Virginia Commonwealth University Medical College of Virginia.

With 15 years of hands-on hematology and coagulation benchwork, plus leadership and management, process development, quality, compliance, and teaching, Dr. Brice brings a rare blend of clinical expertise and strategic insight. Her research and contributions have been featured at major conferences, including multiple abstract posters presented at AACC's annual meeting in Chicago on topics like quality utilization and laboratory testing and rare clotting disorders.

If you've ever wondered how the deep technical knowledge of a lab scientist can influence not just the diagnosis, but the policies, the protocols, and the strategies that guide healthcare systems, Dr. Brice is here to show us exactly how. So let's get into it. Hello, Dr. Brice.

Dr. LaShanta Brice: Hello.

Dr. LaShanta Brice: So, my journey began, like many laboratory professionals. I wanted to do healthcare, but was unsure of what I wanted to do. The thing that drew me to hematology and coagulation was microscopy and the ability to impact the unseen. Over time, I realized, as I grew up in the laboratory under the tutelage of many laboratory professionals within the civilian and military sectors, I realized that the laboratory's voice, through their own professionals, was missing. And this gap is what inspired me to step into a leadership position, not just to advocate for science, but to advocate for the scientists behind it.

Deandre White: That's awesome. So was there a defining moment for you in your career when you realized that lab professionals needed to be a part of the decision-making at the highest levels?

Dr. LaShanta Brice: I know sometimes when people meet me, they don't believe I'm an introvert, but I really am, and this decision was actually not made by me. I was actually put into a position where I was put into a room with many types of healthcare professionals, from pharmacists, pathologists up to discipline-specific clinicians, and that's when I realized that the laboratory professional's voice had to be at a decision-making table. This was specifically important because my own chief of pathology actually put me in this position prior to becoming a DCLS, which made it very clear that we needed to be in the room with those making decisions on hospital protocols.

Dr. LaShanta Brice: One major disconnect is in test utilization. Decisions about what tests to offer or prioritize are often made without consulting those who understand their clinical value and their limitations. This is especially important for laboratory professionals to speak up about. It is almost impossible for any clinician to memorize every type of pre-analytical variable that could impact a test. This can lead to things like over-testing, under-testing, or misinterpretation of lab test results with a consequence for a patient.

Deandre White: And do you think that, um, these policies that you guys are helping to implement, can they vary from hospital to hospital, or do you really think there should be a consensus across the board?

Dr. LaShanta Brice: I think it has to be hospital to hospital. Each hospital serves a unique patient population. For example, I come from a military environment. Those patient populations look very different from a rural hospital versus a hospital that is in a large city versus an academic center. So while standardization is provided through guidelines and guidance documents, it's still very important as an interdisciplinary unit that decision makers get to actually meet together to make what...to make decisions on what is best for their own hospital setting.

Deandre White: I wanted to ask you that because, um, I've worked in a cancer hospital, and we had a VA hospital, like, across the street from us, and patients have gone to both of them, and it really differs the kind of care that they get, and the way that they're even treated by staff, and just, like, the way that they're going about the process of their lab work, all of their testing, and everything like that, so I was wondering if there was really a difference between the two, or there should be a difference between the two.

Dr. LaShanta Brice: Yes, there's always going to be a difference, because it also depends on who is in charge of a laboratory. In the past, traditionally, the laboratory has been overseen, um, by specifically a pathologist. Nowadays, you can have a pathologist oversee the laboratory as the director, a DCLS as a lab director, or even a PhD as a lab director as well. And all of them have unique viewpoints on what should be done for their patient populations.

Dr. LaShanta Brice: Yes, so the inclusion of me as a laboratory professional onto our hospital's anticoagulation subcommittee made a huge difference in developing heparin protocols for that institution. Previously, there was no laboratory representation on the anticoagulation subcommittee, and there was a bit of misunderstanding about what laboratory services could provide and what they could not provide. The thing that was given to this committee by me as a laboratory professional was workflow analysis. Things were talked about included turnaround time expectations, as well as critical result relay.

Deandre White: Can you speak more on that, on why they even needed to have a separate heparin protocol?

Dr. LaShanta Brice: Yes. So, for each patient population, whether you have cardiac patients, pediatric patients, or general patients that are being seen for venous thromboembolism or pulmonary embolism, you need to have protocols set up for heparin delivery. However, the heparin change, or the medication change, is based on lab test results. It is not a gestalt or a feeling that the clinician gets. Certainly, the only way that you would be able to see that there's an issue with anticoagulation is when a patient has a clot or when they bleed. And that is a thing that we're trying to prevent the patient from having.

So in this case, the laboratorian's voice must be heard on what the laboratory can deliver as test results within a timely manner. So when we talked about turnaround time expectations, oftentimes, when you go into literature, you'll see how long it takes to actually perform a test. That does not include the actual time it takes for the sample to get to the laboratory, nor does it include the part where a critical result may have to be relayed to someone that would become responsible for that result. All of those times have to be taken into consideration before developing a protocol so that expectations from both the clinical team and the laboratory can be appropriately established.

Deandre White: Okay, and does this protocol also influence the accuracy of the results? Like, is it important to, like, kind of keep the blood moving, so to speak, when you're measuring coagulation for patients?

Dr. LaShanta Brice: It is important that the sample get to the laboratory in a timely manner, and there is a difference, actually, between if you're going to use anti-Xa protocol versus a PTT (partial thromboplastin time) protocol. There are hospitals throughout the United States and the North American market that have either an anti-Xa only, a PTT-only protocol, or a hybrid model. In this case, the laboratorian can help bridge the gap in knowledge in which test performs the best with each patient population, as well as actually give them the pre-analytical variables that must be present in order for the sample to be appropriately tested.

Deandre White: There's so much that goes into this. I think people don't even realize.

Dr. LaShanta Brice: Yes.

Deandre White: So at AACC, you presented on quality utilization and lab testing, and on rare clotting disorders. How do these kinds of research efforts influence healthcare decisions beyond the lab, do you think?

Dr. LaShanta Brice: This actually can help form an interdisciplinary team speaking on the rare clotting disorders. This specific poster that I did was on a patient that was not traditionally in an area where you would think a clot would occur. Specifically, this was an antepartum patient that required test utilization efforts from both the antepartum team, nephrology and pathology itself. So, a room full of 8 to 10 people were trying to make a diagnosis on a rare clotting disorder to save this patient's life. But the thing that was most pertinent for all of the team members to understand was test utilization. In this case, the hospital could not perform all tests needed to actually diagnose this patient. This also meant that between each team member, we needed to share expectations for send-out tests, as well as tests that were being performed inside the hospital. When we think about testing utilization, we need to emphasize to all healthcare providers that this is not just a laboratory initiative. It informs clinical guidelines, insurance coverage, and even sometimes public health policy, like what we saw with COVID-19. When laboratorians are able to present data on how a test improves outcomes or reduces costs, it can empower those decision makers to make evidence-based decisions, as opposed to decisions that are made in the moment only.

Deandre White: And do you think it's common for hospitals to have tests that they don't have access to, or they just don't know how to use? Because when you think about a hospital and all the labs that they have, it's, like, a long list that they have available to them, technically. But as far as, like, them being able to use it, or even knowing how to use it, is a completely shorter list, I guess, and a completely different story. So do you think it's often where there's actually not a test available technically, for them to be able to use, or they just really don't know how to use it or when to implement it?

Dr. LaShanta Brice: So, oftentimes, a laboratory is a black box, and whatever is available via the internet, there is a perception that it is automatically available from the laboratory, and that is true for more basic tests. But when we start to look at things in coagulation and in more esoteric sections like molecular diagnostics or flow cytometry, some of those tests, although available in the market, may not actually be available at your hospital. So, when clinicians order these tests, they are not necessarily aware of the time that it's going to take to actually get results back. This can impact a patient's care pathway, especially when the results are needed urgently. Is it fair to say that all hospitals should have every single laboratory test available? It would be nice if we had unlimited resources to be able to do that, but that's simply a limitation of the hospital's budget and the hospital's personnel. So, the ability to have routine testing is something that is a reasonable request, but specialized testing, you may need to actually contact your laboratory to make sure that they are available in-house, or who to actually send those tests out to.

Deandre White: Thank you for that clarification, and I think that also helps patients that are... people that are watching to understand why some of their labs might take so long when they're inpatient and getting, like, let's say, complicated labs in a hospital setting. In your current role in scientific engagement and clinical education, how do you bridge the gap between lab science, clinical teams, and industry leaders, do you think?

Dr. LaShanta Brice: I have to act as a translator, and that was something that I had to learn throughout my career as a medical laboratory scientist, and then up to a DCLS. The point of acting as a translator is to actually read relatively heavy scientific jargon, and then be able to translate those for people at their level. So, for example, it is presumed that most people can actually read a scientific article. But that's not the point of being the translator. We know that people can read, but do they actually understand what they're reading? So, for example, when I look at an anticoagulation guidance document, what I give as a piece of information to pharmacy may look very different than what I give a pathologist, which may also look very different than what I would give someone that is in research and development. Each of them do need pieces of information from the guidance document, but they don't necessarily need that information in the form that it's in. What pharmacy may care about may be just what do I need to know to be able to safely anticoagulate my patients? Do I necessarily need all of the scientific jargon surrounded regarding vendors and their actual components of the test, or do I actually just need the actual nomogram to actually give what my patients need? Whereas the industry partner may actually need all of the research and development data because they are interested in actually making a product that would serve the needs of the pharmacist. So that's a good way to act as a translator, but it takes a lot of upkeeping to act as a translator, but a laboratory professional is the best person, I think that can serve as that translator.

Deandre White: And it definitely helps to streamline the process between different groups and communicate things effectively.

Dr. LaShanta Brice: Yes.

Dr. LaShanta Brice: So this is actually a two-part problem. As I mentioned earlier, sometimes when we think of laboratory professionals, we assign them the personality trait of introvert and typically, introverts don't like the idea of visibility, so that's one of our barriers, is visibility. Laboratory professionals are oftentimes seen as support staff only, rather than strategic partners. So in the role of a support staff, you're okay as long as you get what you need from the support staff. But what actually needs to happen is visibility. To change that, healthcare organizations must begin including laboratory leaders in interdisciplinary committees, invest in leadership training for laboratory staff to break them out of the idea that we are support staff, and foster a culture where data-driven insights are valued across multiple departments. So while I focus very much heavily on hematology and coagulation, in reality, hematology coagulation, and clinical chemistry, microbiology, transfusion medicine, all of those departments are cross-functional. One time in my career, I heard a pathologist say that I am one of the only scientific disciplines that touches every single patient, and that is true. Pathology and laboratory medicine touches every single patient every single time they are seen by their clinician. But the problem is, is that we are not visibly seen, unlike your physician associates, your nurses or your physicians. We can change that by stepping outside of the walls of a laboratory and in my current position, that is something that I have to do.

Deandre White: And having that visibility, do you think would really, kind of open people's eyes to what you can offer to a hospital team.

Dr. LaShanta Brice: Yes, because right now the idea of the laboratory is slightly confounded. When patients see the word laboratory, they are oftentimes confounding that with what is called a draw station or phlebotomy station. Phlebotomists and draw station staff are very much a part of the laboratory team. But for purposes of where they are located, they are actually not located inside of the laboratory. They are actually an important part of getting us a pre-analytical piece taken care of before samples arrive to the laboratory. The laboratory itself is where testing is performed. So in that case, when we think about where someone should be seen, technically, clinical staff could come to the laboratory and ask questions. But I think right now, laboratory staff and clinicians don't know very much about each other. So to fix that, this is why we mentioned earlier about serving on interdisciplinary committees. Now, while I may have served on our anticoagulation subcommittee, that can now open the door for a clinician that happens to be on that subcommittee that might have a microbiology question. I can now introduce them to people that work in microbiology and make that connection for them. So while you may be a discipline-specific person, you can serve as a conduit for getting other types of questions outside your expertise answered as well.

Dr. LaShanta Brice: Ask informed questions, like how and who actually interpret their lab test results, and who selected those tests? Oftentimes, there is a small disconnect about how a test is ordered and who is actually interpreting them. When we think of the primary care model present in the United States, the primary care person may actually reflex their testing over to a specialist, but oftentimes that's not communicated to a patient. So, to help them understand that, it is important that healthcare providers be transparent about the reasoning why they're ordering a test. They can also advocate for a second opinion, in the case where they do not believe that the test has been interpreted correctly, they can also have the option to ask if a specialist can interpret it. Or, further down the line, if they know someone that is in the laboratory setting, they can also have the laboratory be contacted to help with interpreting those results.

Deandre White: Can you give an example of a situation where a patient would...should be advocating to ask about how their tests are being done, and in that sort of situation, because I feel like for a lot of patients, when they're going to their primary care provider, they're thinking of, like, A1C, or they're thinking of basic CBC. Give us an example of where that would really be important for a patient to understand and to know.

Dr. LaShanta Brice: So, we'll take A1C for an example, and I know probably the listeners are like, you are not a clinical chemist. However, I am a PCOS advocacy patient advocate, and one of the things that PCOS patients get measured pretty often is an A1C. So in this case, where I would have been the patient that would have went to my primary care to get an A1C done, let's say that my A1C was 5.6. So the cutoff for diagnosing or suspecting a patient with prediabetes would be a little bit above 5.7. So 5.6, we're pretty close. And my primary care says, we don't see anything wrong with your blood sugar. I think that we will order an A1C in the next year at your next annual physical, but let's say I disclose to my primary care that I have a long history of family members that have diabetes, and I am very concerned. In this case, what the primary care could do is they could reflex my concern over to either an endocrinologist or a nephrologist depending on if I had some kidney work done as well. So in this case, this is a patient asking, based on their own experience with their family members, to actually be referred to a specialist due to concern. Now, the primary care could sit and explain further what the A1C actually reveals with their potential for diabetes development, or they can elect to send them over to an endocrinologist who will go further into detail and may recommend additional testing.

Deandre White: Thank you. So this one's for healthcare administrators. What's one actionable step that they can take today to bring lab voices into strategic planning?

Dr. LaShanta Brice: So, one thing they can do is invite laboratory leaders to the table, and it doesn't have to be based on what they perceive to be a laboratory issue. So oftentimes, when we think of budget, we say, we're going to invite the following decision makers to the table, and they leave the laboratory out completely. One of the things that the laboratory does is they provide services to the hospital, and some of the things that they are doing actually saves the hospital money. Like, it takes the patients through a pathway that will get them out of the door and into home care much quicker. But if you don't invite lab leaders to the table, you may not be aware of such initiatives. You can also invite them to make a decision about technology adoption. When we think of things like imaging, the coagulation department plays a significant role in imaging costs through the ER, because they can help you with a specific test that would tell you whether the person is at true risk for venous thromboembolism or pulmonary embolism based on a test. But if you don't invite laboratory leaders to the table, then you won't necessarily know anything about the cost saving initiative. For the laboratory leaders, they need to promote themselves as they are integrative, strategic additions to the table. They are not supposed to be there just for the sake of inclusion, but for the purpose of integration.

Deandre White: What would you say to lab leadership members who have kind of tried to take these initiatives, but let's say their hospital system is a little bit more rigid in, like, their perception of what the laboratory does for their hospital?

Dr. LaShanta Brice: So in this case, they're going to have to start to make themselves known to other departments, as opposed to going to...potentially going directly to the table and what I mean by that is make partnerships with pharmacy, make partnerships with nursing, make sure that when they have their professional celebration weeks, that you are present there. Thank them for their service. We oftentimes complain about, each professional will complain about, we are preaching to their choir. Well, in this case, you can actually reach across the aisle and say, you know, for nursing professional week, we're going to come, and we're going to celebrate with you. By contrast, they can also come in April for laboratory professionals week and celebrate with you. And this is a way that when those already decision makers are at the table, they can look around and say, you know what? I think my friend down in the laboratory should also be at this table with us.

Deandre White: That's a good way to practice advocacy.

Dr. LaShanta Brice: Communication is going to be key, and then also recognizing your own communication style and how it can fit or contrast with other types of communication styles. When we talked about a seat at the table, these individuals happen to be people that have a more dominant personality and are quick to make decisions. Whereas laboratory professionals may not have that same personality type, and may be a little bit slower to make a decision. But recognizing that can help dominant types of personalities slow their decision-making down so that they can take into account multiple steps that they may be missing without the laboratorian's voice there. Their ability to, or our ability to actually translate complex data into actual actionable insights becomes very important, whereas our strategic thinkers at the table may be looking at something at 30,000 feet, it is important to actually look at what is happening on the ground level so that you can take into account some of those pieces of groundwork into incorporation to make sure that when you do make your final decision, that it is equitable and fair for all departments involved. For those that are seeking leadership type of positions, seek mentorship. And when I say mentorship, do not do discipline-specific only.

Make sure you branch out to all types of laboratory professionals, and even those that are outside the laboratory profession. It is important that you make those connections, because you never know when those connections are then going to be very important. A good example of this is during my DCLS residency, I am very much known as a hematology and coagulation person. However, as a DCLS, I must function in all disciplines of laboratory medicine. To help me with that, I had already began making connections with the PhD microbiologists that oversaw our clinical microbiology section, as well as the chief of transfusion medicine. Because I knew that I was deficient in those sections and would need help once I went into residency. So again, making those mentorship connections became very helpful, especially since the Chief of Transfusion Medicine was actually one of the individuals that wrote a scholarship recommendation for me, later down the line.

Deandre White: Thank you, Dr. Brice, for sharing with us that the lab's role doesn't end when the results are reported, it continues in how those lab test results inform strategy, policy, and patient outcomes. So to our listeners, remember, every strong healthcare decision is built on accurate, timely, and well-interpreted diagnostic information. And giving laboratory professionals a voice in those decisions isn't just smart, but it's essential for patient safety and better outcomes for their care. So, as always, I'm Deandre White. Thank you for joining us, and stay curious.

Diagnostic Equity Resources

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