The Laboratory

“Hey, Jaded Julie, we’re going to leave the crystal ball and talk about the hospital laboratory.”

“Curmudge, when you see a modern lab, you’ll think that everything in your crystal ball had already happened.”

“Some things don’t change, Julie. While clients tend to take them for granted, labs of all types have always needed to demonstrate excellent accuracy and responsiveness. And here’s another example: My industrial labs used to solve people’s problems, while clinical labs provide more than 70% of the data used by physicians to manage patient diagnosis and treatment.”

“If we are going to talk about laboratories, we should probably begin at the beginning—with the patient. My years of experience with this blog tell me that the curtain is about to go up on another of our Curmudge-and-Julie theatricals. I might as well roll up my sleeve.”

“You are going to play the patient, Julie, and here comes a phlebotomist to draw some of your blood”

“To a phlebotomist, the world consists of two kinds of people, ‘hard sticks’ and ‘easy sticks.’ Fortunately I’m an easy stick…see, that didn’t hurt a bit. My blood was drawn into little evacuated tubes labeled with my name, date of birth, specimen number, and a bar code. Of course, before starting the procedure, the phlebotomist asked me to recite my last name and birth date to be certain she had the right patient. She also smiled at me, introduced herself, and gave me an empty cup to take into the ladies’ room.”

“Here we are in the hospital basement, Julie. The morgue, down that hall, is not going to be part of our tour. When the lab was expanded a few years ago, it was relocated down here. Design of the laboratory’s space—to increase efficiency and reduce wasted motion—was one of the hospital’s first Lean projects. Our guide through the lab will be Mary Dikeman, Laboratory Manager.”

“It’s a good thing that you aren’t the guide, Curmudge. You never knew much about clinical labs, and what you did know is 40 years out of date. ‘Good morning, Mary. Thank you for taking time to show us around.’”

“Welcome to our laboratory, Julie and Curmudge. Most people don’t know how large the laboratory is and how many interesting things go on here. This is a walk through St. Elizabeth Laboratory, but it describes some of the same things that go on at any of the hospital labs.

So come on in the front door to Specimen Processing; be mindful of the phlebotomists with their carts leaving the lab to go draw blood from patients. And here comes a courier with a cart full of coolers that contain specimens from other clinics and hospitals. Once in the lab you will notice the technologists and support service technicians are emptying the coolers and then ‘receive’ each specimen in the computer; this tracks the movement of the specimens from site to site. These are sorted and then delivered to the departments such as Chemistry, Hematology, Blood Bank, Microbiology, Cytology, and Histology that will perform the testing. Located in Specimen Processing, the pneumatic tube system also brings specimens to the lab. Centrifuges sit on the counter and are used to spin and separate the cells from the liquid in some of the blood tubes when the tests require serum or plasma instead of whole blood.”

“As we go through the lab, Julie, please notice how important computers are for everything from sample tracking to operating many of the instruments. In my environmental lab, 20 years ago, all we had was Lotus 1-2-3 for sample log-in.”

“And for an old chemist like you, Curmudge, I’d better help Mary by defining some of her terms. Cytology is the study of cells, and histology is the study of tissues.”

“Regrettably, from the experience of my late wife, I have learned a bit about histopathology. “

“Okay, visitors, let’s move on to the right and head into the Blood Bank area. Here you may see boxes that held blood products that were delivered from the Community Blood Center. On the left is a Medical Technologist that has certification from the American Society for Clinical Pathology [MT(ASCP)] that is doing blood typings and cross matches to see what unit of blood will be the best match for the surgery patient. There is an instrument that uses a gel technology to help determine the antibodies that are important to finding a good blood match.

Notice the large refrigerator that holds all the blood bags and blood products. It has a special temperature recording chart that is so important to keeping the blood at the proper temperature at all times to keep it safe. There is also equipment used to prepare platelets for transfusion.”

“All I know about my blood is that it is type A-negative.”

“And Curmudge, it’s being pumped through your ancient circulatory system at glacial speed. Let’s take a break and return next week to continue the tour with Mary.”

Affinity’s Kaizen Curmudgeon