How to Make Friends With the Path Lab – Getting Bloods Right
A medical student and medical scientist takes us on a rare journey from the wards to the lab to make sure we get the tests back as quickly as possible, without a hitch.
Before I made the journey to medical school, I became a medical scientist – a role typically known to the rest of the hospital as ‘path’ or ‘the lab’. While the main part of my job is generating results from the samples we receive, I also spend a lot of time on quality control and assurance tasks to ensure the results that we generate are precise and accurate. However, clashes and miscommunications between the lab and the wards often come about because of the lab’s rigorous concentration on quality, as well as our lack of clinical context, as we’re typically tucked away in the hospital basement.
Many blood test recollects or preanalytical errors can be reduced with some background knowledge in how the lab works. Here’s some advice about how best to order tests from the lab, to help them generate accurate results and decrease your recollection rate, which ultimately will help you get your results faster!
Ask the Lab
This is my first, and most high-yield tip. There are copious types of errors that can be avoided with some communication with the lab. Numerous times I’ve had to call the ward for a sample to be recollected, only for the collector to tell me that they just (incorrectly) guessed which blood tube to use. If you’re not sure about the tube selection, or sample transport requirements, or result turn-around-times, or whether a patient needs to fast for a certain test – please call the lab! Pathology tests are our expertise, and in my (very biased) view I think we’re an under-utilized source of information in the hospital.
Right patient, right time, right documentation. So the six R’s of medication administration don’t quite fit to phlebotomy, but a few do! Make sure you’re requesting tests on the right patient, and that the labels on the tubes match the patient as well as the request slip. I know it’s an obvious tip, but you’d be surprised how often mis-labelling mistakes occur.
Depending on where you work, certain samples may need to be labelled a particular way. For example, in my blood bank, samples for a group and hold must be labelled with handwriting (not printed IDs), and no discrepancies in spelling are tolerated. Blood banks overall tend to be more stringent due to requirements set by legislation. There is no point arguing with the blood bank to get them to accept a rejected sample.
Another quick tip is to always fill out the date and time of collection on the slip, not just on the samples. This includes using 24-hour time. We get some collectors that fail to do that and then later call the lab when they can’t see their results where they expect them. It makes it hard for the treating team to follow trends if collection times aren’t entered correctly, and it creates a mess that ends up needing to be resolved by whoever picks up the error.
Please Be Legible
The trope about doctor’s terrible handwriting exists for a reason. I work in a hospital with handwritten slips, so if you work in the land of electronic requests, feel free to skip this point after taking a moment to acknowledge your good fortune.
Please, for the sanity of your nursing and phlebotomy colleagues, as well as the lab staff, please be legible with your requests. Either we have to waste time trying to track you down to confirm what you wrote, delaying the processing time of the sample, or we don’t receive the correct sample because the collector took an educated guess at what was written and passed the buck onto us to follow it up. We once received a request so badly written that the lab assistant confused ‘coagulation’ for ‘troponin’. At the end of the day messy handwriting delays result reporting, which can cause unnecessary delays in treatment.
Short Sample? Need to Prioritise
We get it. Sometimes it’s a neonate, or a dehydrated patient, or just someone with finicky veins, and you just can’t manage to get a decent sample. In these cases, it’s best to write on the slip which tests you would like us to prioritise. We can then run down the list step-by-step, making sure you get the most pertinent results. Do note this can mean it takes longer for results to be released, as it involves multiple steps and more manual handling of the sample by lab staff. If you’ve got a short sample with urgent requests, you can call your lab to find out the best way to get timely results.
If Everything is Urgent, Nothing is Urgent
The title says it all, really. Please learn what constitutes an urgent request at your workplace, and only order them when indicated. Along the same lines, please write some basic clinical notes on the request slip. In some labs, the pathology staff do not have access to the hospital’s IT system, so cannot see how acutely unwell a patient is. To give an obvious example, I will prioritise a crossmatch request that states ‘actively bleeding’ over a routine pre-op test on a stable patient – but I can’t do that if I don’t have that information given to me.
Add Ons Can Save Time (and blood)
If a patient has already had bloods taken by the phlebotomy round, but your consultant wants another test done, sometimes you can avoid another stick by adding on to the previous sample. Obviously this won’t be suitable for more acute, time-sensitive tests; but the patient’s HbA1C shouldn’t have changed in the six hours since their last blood draw. If the correct tube was taken previously and there is sufficient volume left, you should be able to add on tests to it. There are caveats, as well – some analytes are unstable in samples out of the body and should not be tested on older samples. Again, if you are unsure of any of the above, you can always call the lab.
Remember, the hospital is an ecosystem, we all work in synergy with each other. So understanding the role each cog plays in the wheel will help us work more efficiently and effectively.
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