Many people don’t realize how many different branches of pathology there are. With five main subspecialties (medical microbiology, histopathology, hematology, clinical biochemistry, and immunology) and nine smaller ones (virology, cytology, toxicology, forensic pathology, dermatopathology, and so on), the laboratory may seem like a crowded place – and that’s even before counting the clinical directors, lab managers, biomedical scientists, clinical scientists, trainees, associate practitioners, healthcare assistants, and porters.
So who are these “hidden heroes?” Today, I’d like to focus on the work done by medical lab assistants (MLAs) of all grades in all laboratory settings. These members of the lab play a key role in sustaining quality diagnostic services. Their work varies, but includes receiving, sorting, preparing, and processing patient samples; maintaining stocks of consumable items; disposing of biological waste; operating and maintaining laboratory equipment; clerical tasks, such as data entry; and general housekeeping duties in the lab. There are no formal entry requirements for MLAs, although some hospitals and pathology labs require qualifications and some organizations offer training and professional development.
Sample collection for diagnostic testing is the first step in a journey that will involve several hospital departments, different skilled scientists, and state-of-the-art technologies. Notably, the preanalytical steps represent the most vulnerable phase of the testing process. To really understand the hard work of an MLA, it’s important to have a clear understanding of this sample journey. Let’s follow the path of a blood sample. After collection, the sample – in a colored tube that contains different chemicals and preservatives, depending on the tests to be conducted – is delivered to the pathology laboratory along with request forms that specify each test. MLAs are responsible for sample sorting – a crucial step with plenty of room for error, which is why labs employ strict quality control procedures to prevent mix-ups and to ensure accurate results.
Following these quality control measures, the MLAs may reject samples for a variety of reasons: inappropriate sample volume/specimen container/specimen type, sample hemolysis, incomplete or incorrect information on the request form, or lack of the requisite doctor’s signature. If any of these goes undetected upon sample receipt, it may ultimately lead to incorrect results, unnecessary diagnostic procedures, increased healthcare costs, delays in diagnosis or treatment, and even physical harm. During the preanalytical phase, MLAs prepare the samples for testing (by centrifugation, aliquoting, and sorting). They check that patient identifiers are correct and complete, that sample identifiers match those provided on the request form, that the sample type is correct, and that all necessary information is available. Only then can a sample be assigned a unique laboratory requisition number and booked for testing.
Clinical pathology plays an integral role in the patient-centered approach to healthcare. Doctors rely on accurate test results for proper disease diagnosis and treatment – and patient-centered care requires effective interdepartmental cooperation. When things go awry due to undetected errors by lab personnel, it can damage the lab’s reputation, diminish confidence in healthcare services, and contribute to a significant increase in operating costs. Errors can occur at any point during patient sample journey, from the pre-preanalytical to the post-analytical phase, and it’s impossible to eliminate them entirely – but compliance with best practices can significantly reduce their incidence. Responsible for the most error-prone steps in the process, MLAs deserve our thanks. Shouldering the vital task of error detection and prevention is no small feat.
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