Volume 37 Number 6 | December 2023

Thao Vu, MS, MLS(ASCP)CM, ASCLS Today Volunteer Contributor

Thao VuCreating a culture of quality patient care begins with the right lab environment.

As medical laboratory professionals, we have a duty to produce reliable and accurate laboratory results for each patient. Learning should not cease when a diploma and certification are achieved. With our ever-changing laboratory landscape, we need to do our best to maintain technical competency. Continuing education is central to procuring up-to-date knowledge and a solid improvement process. We must seek to further our knowledge of what we are responsible for delivering.

The laboratory world constantly has new developments in all department areas. Knowledge is one factor, and adaptability is another factor. In a previous job, a smaller community hospital still utilized the bleeding time test. Despite being largely considered as an outdated test, it was difficult to move away from it due to the long duration of usage and lulling into comforts of everyday habits. There was an unwillingness to adapt, regardless of the knowledge that the Platelet Function Assay was the better replacement. Consequently, knowledge is wasted if it is not applied or shared.

“Learning, willingness to adapt, compassion, and collaborative communication leads to a conducive setting for producing quality laboratory results.”

Not only do we have that responsibility to learn and to adapt, but we also need to be compassionate to ourselves and each other during this undertaking. Despite the best of intentions and efforts, something inevitably breaks down in the lab, specimen quality issues occur, there are resulting errors, and so forth. It is a struggle to remain calm and composed to consistently prevent and put out metaphorical fires. It makes it more difficult when the laboratory professional feels alone, unsupported, and denigrated for their efforts.

Each of us has made mistakes. Be kind to ourselves. Proceed onwards by showing determination not to make the same mistake again and to gain wisdom from that experience. As we hope others do for us, extend our grace and patience to everyone. Ignorance of laboratory expectations and procedures should be met with listening, understanding, and guidance. Each laboratory professional has the capacity to learn and to improve.

In addition to continuing education and adaptability, effective communication is also important. We have all fielded incoming angry phone calls. One common phone call may be from a nurse who is upset that the lab requested a redraw for a hemolyzed sample. When met with hostility, there may be a visceral reaction to react back in anger. However, we are medical laboratory professionals, and we must not lose sight of our duty to the patients.

Keep patients as the focal point and that would be akin to a compass pointing north. It helps to guide our attitudes and actions towards one direction, which is delivering quality patient care. Good communication allows the healthcare team to be on the same page and work more effectively toward better patient outcomes. We come from different backgrounds and should utilize our expertise for our patients. In this scenario, we should remain calm and professional. Share our knowledge with the nurse.

What can be done to minimize hemolysis?
Examples (CDC, 2023; Wan Azman et al., 2019):

  1. Use correct needle size for blood collection (20-22 gauge).
  2. Avoid line draws; IV devices can hemolyze red cells.
  3. Avoid prolonged tourniquet.
  4. Ensure proper tube mixing; do not mix vigorously.
  5. Use appropriate pulling pressure when drawing with syringes; do not cause excessive suction.
  6. If needed, warm up the venipuncture site to help increase blood flow.
  7. Allow tube to completely fill.

Why does the lab need a non-hemolyzed sample? Why can’t the lab use the hemolyzed sample?

  • Hemolyzed specimens can interfere with laboratory testing and therefore produce unreliable test results. A good specimen is needed to obtain accurate test results.

By taking the time to calmly listen and to guide, we are lending a hand and helping the nurse to obtain a proper specimen. We can recognize the challenges that they may face themselves on the frontline with hostile patients, patients’ family, and even physicians. By talking to the other person peacefully, you are giving them space and opportunity to move away from their negative attitude. Their initial tone of voice may not be reflective of the person, but can be due to the high-pressure circumstances that the person was in. Of course, medical laboratory professionals should not be punching bags or doormats. If we are unable to get a word through, we can state in a firm, yet peaceful, manner that we will talk to them when they are ready to be professionally respectful.

Ultimately, good communication will benefit the patient. By taking the time to work towards resolving the issue with another member of the healthcare team, we are helping patients. In the hemolyzed specimen scenario, we are working towards minimizing further patient blood draws. Additionally, that also helps us to deliver patient test results in a timely manner. All of that leads to better patient care. In the long term, effective and empathetic communication builds confidence, trust, and respect for our field.

Overall, are we harnessing the full potential of our technologies and human assets? Learning, willingness to adapt, compassion, and collaborative communication leads to a conducive setting for producing quality laboratory results. What we allow to grow will grow. Therefore, creating a culture of quality patient care starts with the laboratory environment.

  1. Centers for Disease Control and Prevention. (2023, June 29). A Quick-Reference Tool for Hemolysis Status. Centers for Disease Control and Prevention. https://www.cdc.gov/ncezid/dvbd/specimensub/hemolysis-palette.html
  2. Wan Azman, W. N., Omar, J., Koon, T. S., & Tuan Ismail, T. S. (2019). Hemolyzed Specimens: Major Challenge for Identifying and Rejecting Specimens in Clinical Laboratories. Oman Medical Journal, 34(2), 94–98. https://doi.org/10.5001/omj.2019.19

Thao Vu is Assistant Professor for the Department of Laboratory Sciences at the University of Arkansas for Medical Sciences in Little Rock, Arkansas.