1. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 39 Introduction to the Medical Laboratory

2. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Physician’s office laboratory (POL) obtains and tests specimens Specimen obtained at POL and transported to separate lab for testing Collected and tested at separate lab

3. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Purposes of lab testing –Record individual’s state of health Routine physical examination Provides baseline values for comparison –Satisfy employment, insurance, or legal requirements Employment-required drug and alcohol testing –Research statistics and clinical trials

4. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Purposes of lab testing –To detect asymptomatic conditions or diseases No symptoms associated with disease process Routine screening in another area reveals disorder –To confirm a clinical diagnosis Diagnosis determined through subjective and objective information Tests given to confirm diagnosis

5. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Purposes of lab testing –To differentiate between two or more diseases Perform simplest and least invasive test Rule out a disease (differential diagnosis) –To diagnose If symptoms are vague Panel, or group of related tests Helps narrow field for diagnosis

6. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Purposes of lab testing –To determine the effectiveness of treatments –To prevent diseases/disorders –To prevent the exacerbation of diseases Patients with chronic conditions May need to adjust diet or medication

7. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Types of laboratories –Independent –Satellite –Hospital-based –Reference

8. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Types of laboratories –Point-of-care testing (POCT) Near-patient testing or bedside testing Brings laboratory services directly to patient Rapid, accurate results

9. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Types of laboratories –POLs Physically set within office Types of tests commonly performed Use of self-contained tests At-home test kits

10. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Laboratory personnel –Pathologist –Clinical laboratory scientists –Technicians –Clinical laboratory assistants –Phlebotomists –Medical assistants

11. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Laboratory departments Hematology Urinalysis Clinical chemistry Immunohematology Serology (immunology) Toxicology DNA Microbiology Parasitology Cytology Histology

12. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Laboratory Panels of laboratory tests –Tests categorized into related groups –Formerly called “profiles” –CMS-approved organ- and disease-oriented panels

13. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Billing for Laboratory Services Providers justify lab tests ordered by using correct diagnosis code If provider wants to order a test not covered by insurance, patient should sign waiver If clinic fails to notify patient, patient does not pay for test; provider liable for charges

14. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Quality Controls/Assurances Control tests –Have known value/results –Compare with results of patient’s test –Minimizes human error –Checks reagents/chemicals Proficiency testing –Similar to quality control

15. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Quality Controls/Assurances Preventive maintenance –Helps identify potential problems before they occur –Manufacturer’s recommended maintenance Instrument validations –Checks calibration and linear range of instruments and machines

16. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Quality Controls/Assurances The medical assistant’s role –Perform administrative office duties –Prepare patients –Collect specimens –Perform waived tests

17. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Quality Controls/Assurances The medical assistant’s role –When patient prepared properly: Specimen obtained expertly Reagents and equipment in best condition and calibration Test performed by trained professional Test results accurate

18. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Laboratory Requisitions and Reports Written requisition for laboratory work must be sent to lab with patient or specimen –Preprinted –Computer-generated

19. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Laboratory Requisitions and Reports Features of requisition –Provider’s information –Patient’s name, address, phone numbers –Patient’s billing information –Unique patient identifier –Patient’s age/date of birth and sex –Source of specimen –Time and date of specimen collection

20. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Laboratory Requisitions and Reports Features of requisition –Test requested –Medications patient is taking –Clinical diagnosis –Urgency of results –Special collection/patient instructions –Other provider(s) to receive copies of report

21. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Laboratory Requisitions and Reports Features of written lab reports –Laboratory name, address, and phone numbers –Referring provider’s name and identification numbers –Patient’s name, ID number, age, sex

22. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Laboratory Requisitions and Reports Features of written lab reports –Date specimen was received by laboratory –Date and time specimen was collected –Date laboratory reported results –Test name, results, and normal reference ranges

23. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Laboratory Requisitions and Reports Attach to patient’s chart Notify provider of abnormal results Computerized laboratory report >>

24. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Specimens Proper procurement, storage, and handling –Obtain from independent laboratories –Instruction manual –Obtain specimen in proper manner –Use right equipment –Guidelines

25. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Specimens

26. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Specimens Processing/sending specimens to lab –Patient’s insurance often dictates laboratory contracted –Often differences between laboratories –Type of specimen acceptable for one laboratory not necessarily acceptable specimen for another

27. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Microscopes One of the most used pieces of equipment in laboratory Parts –Light source –Eyepieces –Objectives –Condenser –Diaphragm

28. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Microscopes Types of microscopes –Compound –Phase contrast –Fluorescent –Electron

29. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Microscopes How to use a microscope –Adjusting focus with coarse and fine adjustments –Raise platform of lower objectives using coarse adjustment and low-power objective while viewing slide from side –Control intensity of light with condenser and iris diaphragm –Oil-immersion lens

30. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Microscopes How to care for a microscope Proper way to carry a microscope >>

31. © 2014 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Microscopes How to care for a microscope –Follow manufacturer’s and clinic’s rules –Carry with one hand securely supporting base and other hand holding arm –Cover microscope when not in use –Clean lenses with special lens paper after each use –Always move platform away from, never toward, eyepiece –Use oil only with oil-immersion lens