The Magical World of The Lab
In this section, we are going to following a sample of you through The Lab…where does it go, and how do the results of testing get back to the doctor or nurse who will use them to guide decisions impacting your care.
Obtaining a sample of You…
Most of us have experienced an illness requiring a visit to a clinic or hospital. A typical encounter involves an attending doctor who, among many activities, may order a blood test. Does the doc draw the blood? Rarely. More often, a Phlebotomist draws the sample; that Phlebotomist is a lab person. A Phlebotomist is a really talented individual who has been taught how to find a vein, insert a needle, collect the correct blood sample (not too much, not too little, the right additive to preserve the sample), and do so while distracting you such that you are not even aware that they inserted a needle and obtained a tube of blood - i.e. painless. That is a true Lab Professional. The Phlebotomist is the face of the lab, that bright, smiley person who may wake you at 4 AM to begin your hospital day…Good Morning!
Once in a while the attending doctor or nurse may attempt to collect a blood sample, and on a rare occasion, they can’t find the vein. Who do they call? The Phlebotomist!! (Accompany that thought with the tune from the Ghost Busters - Who Do They Call?) Phlebotomists are really good at this. Some health care centers create a group of experienced Phlebotomists called “The Line Team” who are called when nobody else can find a vein. Who do you call?? The Line Team - these are the pro’s.
In another scenario, the attending doctor may decide that a tissue sample is needed for evaluation. Sample collection may occur during surgery or in an outpatient setting using a needle to collect the sample; this is called a needle biopsy. Or the sample may be collected using a swab (sterilized cotton on a stick) to obtain a sample of fluid or cells representative of the sight of clinical interest, such an infection. A member of the doctors team, following detailed instructions from The Lab, manages the sample to ensure it is stabilized (we don’t want to mismanage that precious piece of you that requires evaluation) and sent to The Lab chop chop, ASAP, sooner than now…expedited delivery, etc. And, sometimes, The Lab is right in the doctors office.
Sidebar 1:
Clinical Labs come in all shapes and colors. Some collect specimens, some process specimens, some perform analysis, some report results, some support the infrastructure that facilitates all the work, and some do it all; It depends upon the size of the enterprise.
In the year 2005, a very intelligent and highly regarded health care administrator published a finding - 70% of the information in a patient's medical record that influences clinical decisions originates from The Lab. This published finding has been recognized internationally.
Sidebar 2:
Virtually every health care center in the US maintains a facility called The Lab. The Federal government allows clinical laboratories to operate in many different environments, and there are lots of them…345,000 at last count. They may be a doctors office, a skilled nursing facility, a reference laboratory, a clinic, or a hospital.
Sometimes The Lab is in a box; this is one of many devices created by large technology companies (examples: Abbott, Bayer, BD, Lifescan, Roche, Siemens, to name only a few) designed for rapid testing in the doctors office, a skilled nursing facility, surgery, or the hospital Emergency Room. This is called Point of Care testing. Have you had a blood glucose test at the doctors office or nursing facility? This is example of a Point of Care test. While Point of Care testing is fast, it can be an expensive way to perform testing, and the menu of tests available is limited to results needed to manage life threatening illness NOW (i.e. results in a few minutes).
The vast majority (more than 70%) of all tests are performed at a central clinical lab, a hospital lab, or a reference lab. These are the routine tests performed to assess body function - heart, lung, kidney, liver, blood flow, evaluate for infection, assess cell or organ anatomy or physiology, or one or more of the many other bodily activities involved in maintaining health. Typically, clinic or hospital labs maintain a test menu of around 400 unique tests available 24 hours per day, every day of the week.
Sometimes doctors use a reference lab, a lab separate from the routine clinical or hospital lab. Examples of reference labs include LabCorp, Mayo Clinical Lab, Quest, AML, ARUP (listed in order of national use frequency), among many. Reference labs are specialized entities engaged in providing very unique testing. While a clinic or hospital lab exists to provide immediate care around the clock to cover 90+% of all diagnosis, reference labs may provide as many as 4,000 unique tests covering every possible subspecialty known to medical care.
In a typical setting, a patient sample, depending upon the medical triage process and disease severity, may progress from doctors office to the clinic or the hospital, and if specialty care is required, on to the reference lab.
Some doctors offices are located in areas not easily covered by a local clinic or hospital. These doctors offices may use a reference lab that provides local pickup and analysis services.
Why do I tell you this convoluted story - who cares? OK, think about it this way. In a typical year, 14 billion (Yes BILLION) specimens flow through this process in the US. The results of testing get back in your medical record within a day or two. Put that in the context of the Internal Revenue Service, an agency that handles a similar volume of data with result turnaround maybe next year, if you are lucky.
