Chapter 1 Lecture Recording - Phlebotomy Past and Present

Hello class, this is Professor Torus. Today, we're going to go over chapter one, um, which is phlebotomy: Past and Present. And the hell Cur setting over here is the uh objectives uh for this chapter. Feel free, feel free to pause the video and read them.

From the beginning of times, humans have performed some type of phlebotomy procedures. In early times, people believed that their blood has some connection with their well-being. A Greek physician named Hippocrates, which is also known as the father of medicine, believed that a good heal required a balance in four humors in the body. They consist on blood, phlegm, black bile, and yellow bile. It was believed that the Sease resulted from the excess of one or more of these substances and that by removing the excess will restore the health.

So, removing blood was called uh bloodletting, and the most common way of performing these was by venesection, which means cutting a vein. Uh, venesection comes from the Latin word *vena*, which means vein, and *section*, which means cutting. But of course, uh, we do not use use this word now. The word that we use is phlebotomy. So, what does phlebotomy mean? So, phlebotomy comes from the Greek words *phle* uh, *phle*, sorry, *phlebos*, which means vein, and *tomy*, which means cut or incision. Uh, you definitely need to know what phlebotomy uh means and where it comes from, okay?

So also, uh, in the Middle Ages, there were some uh barber surgeons that performed that bloodletting and leeching. Uh, the barber's pole, you've probably seen it here and there, had those red and white colors. The red color represented the blood, while the white uh color represented the bandages, which are were also used as tourniquets. Um, and in the 17th, 18th century, phlebotomy became a major therapy. Um, and they were also using this cupping and leeching uh to remove that excess blood.

The cupping, which is an application of heated suction device, which, and I believe there is maybe a picture in your book, uh, that you can see. Uh, it was basically used to drain the blood in it. Um, now leeching has also been used, and uh, the way where use this uh type of leech called the *Hirudo medicinalis*. Um, and basically what they do, they either put like a a little drop of milk or a little uh blood placed on the patient's skin, and then that's when the leech actually gets attracted to it and and leeches into that part.

One of the things that the leech has is that it uh injects this anesthetic, so you don't feel the pain, and it has the anticoagulant that prevents any type of clotting while it's sucking that blood. It is continuing to be used in some microsurgical uh, re-plantations of uh, like fingers or or things like that. And basically, what it does, it it removes that pool of blood that it's around that, and uh, any type of clots it gets also uh removed.

So, what are the goals for uh and methods of phlebotomy today? So, of course, the goals is to obtain that blood in order to screen and diagnose um any type of illness on a patient. Uh, also, it can be uh uh to remove blood for transfusion at a donor center, or perhaps to remove for therapeutic purposes. One of these uh therapeutic uh purposes will be like polycythemia and or hemochromatosis. Uh, again, that is done more at the donor center. And perhaps if we have time this year, not 100% sure, we can go and visit the donor center on PO Po and also uh discuss a little more about it. But make sure that you know what are the three goals of phlebotomy.

Of course, what are some of the methods used? The main method that we use is the venipuncture, right, in which you uh collect the blood via a needle that gets inserted into the vein. Or it could also be a capillary puncture, and which you know, you get a lancet, get a little uh uh uh sharp object that when you click on that lancet, it will make a cut, and that's how you uh collect the blood. And we'll talk about capillary punctures in another chapter later on. Um, and also, uh, we draw blood through uh vascular access devices like an IV, you know. But again, that is kind of like a venipuncture because they went through a vein. So, those are the methods.

So, what is the uh role of the phlebotomist? So, the phlebotomist, um, it's basically anybody trained in blood collection. So, individuals that are trained on how to collect blood, you can call that a a phlebotomist, right? Uh, and for example, uh, a nurse that collects blood, you know, at that moment, she is considered a phlebotomist because she is drawing that blood.

What are the skills, knowledge, and competencies needed? Well, um, you must be able to um have this special communication, okay, and organization skills. So, what it means is that you need to be able to uh communicate with the patient, understand the situation, make sure that they feel comfortable with it, and make sure that you know what you're doing too, and understand and adapt to the new technology that is coming out in in um in this uh medical field. Make sure that you know also what type of test that is needed to be collected, so that way you can collect the uh proper type of um uh of tubes, you know, because it's not only about just sticking the needle on somebody and you know, getting blood. You need to be able to understand what type of tubes to collect. And we'll talk about those tubes, I believe, maybe a little bit in this chapter, but not too much. We will talk about it in another chapter, okay?

Confident in professionalism of phlebotomists, right? Phlebotomists will find that when dealing with patients who are ill or irritable, sometimes those patients are um upset, sometimes they can be a little disruptive, you know. Understand that you're going to be dealing with individuals that are not feeling well, so you need to be not only uh show that professionalism but also confident on what you're going to do.

For example, I, I remember a time in which I was a student and as an MLT student, and we'll talk about what's an MLT a little later. As an MLT student, uh, they basically left me alone to uh draw patients. And there was this little group of nursing students that they have them in a little group, and they were, you know, taking turns uh collecting blood from patients. And I remember this patient came to my uh chair and he's like, oh, um, I don't want to go over there. There are a bunch of students. Of course, I saw his veins and I was pretty confident. I said, you know what, he has good veins. I don't see a problem getting, you know, collecting his blood. I feel very confident, even though I was a student. And of course, I, you know, I just said, um, uh, please sir, have a seat. And blah, blah, blah, talked to him, made him comfortable, got his blood real quick, not an issue, no problem. And he actually said to me, wow, um, you were pretty good. I didn't even feel that. And I don't know what came to me. I should have never said that, but I said, well, sir, I, I am a student. And he's like, oh, you lied to me. I said, no, sir, I did not lie because you did not ask me if I was a student. You just said you didn't want to go with those students. So, but again, like I said, um, he said, you did a great job. But the main thing is that you need to have uh those skills, you know, and feel confident and and and and treat everybody uh very professionally. Make sure that you know what you're doing, and you should be uh good to go.

So, what are the typical phlebotomy duties? So, again, the typical duties would be to prepare patients um for collection, right? Make sure that they are aware of what's about to happen. Make sure you uh make them feel comfortable. You collect the blood either by venipuncture or capillary puncture. Make sure you uh once you collect it, you prepare and transport those uh samples to the lab uh properly. Also, make sure you adhere to all the HIPAA and confidentiality guidelines. Don't be um sharing information like, oh, you know, I drew this individual for an HIV test, or, you know what, I drew this patient uh for a hepatitis C. I think they probably have it, or things like that. Make sure that you uh keep everything confidential. Make sure, like I said, once you collect everything, make sure it gets transported on a uh the right amount of time to the laboratory, because most of the time, those, a lot of tests have these turnaround times. And turnaround times, basically, what it means is that there is a specific amount of time that it needs to be uh tested. For example, we have routine testing, we have ASAP, and we have STAT, right? So, routine testing means that it needs to be tested within uh eight hours, uh, most of the time, of course, depending on what type of testing it is, but we can say around eight hours. We also have the ASAP, which means that you have to complete, the lab needs to complete that test uh within a two-hour time frame. And a STAT means that it needs to be done within the hour. The doctor needs that result in order to continue any type of procedure he's doing on the patient. So, it is important that you follow those uh guidelines.

Of course, comply with all the safety rules, policies, and guidance. So, make sure that you know you are always safe, but practice safety, right, when when when doing phlebotomy, because you do have a needle in your hand. So, make sure that you always practice that safety. And we'll, we'll talk a little more about that once uh we start practicing um with the manikins and everything. All right, and provide quality customer service, of course, you know, make sure that you always make the patient feel comfortable, make them feel, you know, uh that you know what you're doing, because you don't want to go in there and be all nervous, and the patient is going through all these issues, through all these uh problems, you know, possibly, and and you not having that confidence and and not knowing, acting like I don't know what I'm doing. A lot of times, it creates also um anxiety on on some of the patients. So, make sure you provide that quality of customer service.

So, some of the additional duties, of course, is assisting in the collecting, documenting, recording workload, right? Sometimes, for example, you're not, you may not be the actual phlebotomist, you may be at the front assisting all the patients that come in, right? Or you may be asked to help with some type of instrumentation to prepare it, or to do some type of quality control on it. You need to make sure also, um, you know how to use a uh a computer, you know, or paperwork, or or anything else that it's also involved within the laboratory. Sometimes you'll be asked to train the new students, you know. So, when you start doing your rotations in the hospitals or the clinics, you're going to see that there's going to be another phlebotomist actually showing you and teaching you on how they do things in that lab. So, that's what we ask you to be respectful, because, you know, one day it may be you doing the same thing with a student. So, those are basically some of the other duties that you may have to do.

Now, one of the things too that you need to be careful is that you should not do any type of direct patient care, okay? You are uh are not authorized to do any type of direct patient care. Like if a doctor, I don't know, asks you, hey, I need you to come and help me perform this surgical procedure, I don't know, something like that, right? I mean, you don't, you're not trained to do that. That's not part of the job description, right? Uh, uh, if the doctor says, go in here and cut here, or or or do this, if you're not trained, you are not supposed to be doing that, okay? Of course, be respectful, say, dog, I'm not trained to do that. Let me go and get somebody. Who do you want me to call? Or whatever the case may be. But of course, don't, don't do anything like that.

For example, I, I wasn't asked, right, but I'm just giving this example. One time, I had to go to the ER because a nurse asked me to draw a patient. So, I was going to draw him, right? But then this doctor came and he's like, no, no, no, no, I'm going to be doing an arterial draw, right? So, what I ended up doing is just stay there so I can collect the blood and take it to the lab. That I was able to do. But let's say, say the doctor says, well, no, I don't want you to do a venipuncture, I want you to go and do an arterial draw. That I will have to say, the doctor, you know, sir, um, sorry, but I cannot perform that because I'm not trained on that. So, make sure that you do not perform any type of duties that are not within your scope.

So, official recognition. Certificate of completion. So, once you finish phlebotomy programs, a lot of them, they offer you like, for example, this one can offer you a certificate of completion. Now, this certificate of completion does not mean that you are basically licensed by the state to do phlebotomy. There are some states that do not, uh, have, uh, a state license, you know. But there are other ones that do. I don't know, I think there's three or four of them that require a license. I think when I say California is one, Washington state, New York. I don't remember the other one, but there's a few of them that do require a license in order to be a phlebotomist. But of course, you, you have to get with, if you, you end up moving or something, make sure you find out if you require to have a license in that state. Here in Texas, it's not required for you to have a license. So, if you have that certificate of completion, right, and the uh hospital or clinic needs a phlebotomist, you can go there and say, well, I am trained, I know phlebotomy and everything, and then they can uh hire you to do phlebotomy.

Now, the national certification. So, what is the national certification? So, national certification is basically an agency that um is going to, it's a test that you take, and once you pass this test, this national agency certifies you that you basically, they're saying, yes, this person knows phlebotomy and they know what they're doing, okay? Basically, what's going to happen is once you pass the test, you're going to be given a title as a phlebotomist, and you're going to be having these initials after your name, in conjunction with the certification agency.

What are some of those uh certification agencies? Are those right there, such as, um, let me see, like this one, AMT and ACP. There's also ASCLS and NCCT. Um, I believe in your book, page, let me see, page eight, table 1-1, you will have there the names of what those initials mean. Like, for example, AMT, AMT means the American Medical Technologists. ACP is the American Society of Clinical Pathologists. Now, these two are the, the most common. And I probably want to say most common, but ACP is also known as the gold standard. What I mean by gold standard is that the ACP, again, stands for the American Society of Clinical Pathologists. Who runs the lab is the pathologist. So, so this is an agency that is run by pathology. So, if this agency basically says that yes, you're a phlebotomist, I mean, who can argue with them, right? Because they are the pathology, they're the ones that run the lab. So, it is very, very prestigious. Everybody knows what, who ACP is. But again, is that the only one that you can get? No. Um, uh, the AMT, American Medical Technologists, that's who I am certified with. And basically, AMT is run by technologists. So, if you're interested in later becoming part of the organization, like, for example, if you want to run for office, I don't know, secretary, treasurer, president, or something like that, then AMT will be the choice because you can, you are a member and you can participate in meetings and things like that. On the ACP, it's again, it's for clinical pathologists, which means it's run by doctors. Only doctors are members. You basically are just being certified by them. So, it just depends again, what, what you want to do. And we can talk this a little more in class. So, if you have any questions, make sure you, uh, ask me or also Professor Moody can give you more information about the ACP. He is certified by ACP. I am certified by AMT.

All right, continuing. Oh, well, one more thing about that. So, for example, for the AMT, your initials will be RPT, which stands for Registered Phlebotomy Technician. And with ACP, your initials will be PBT, which stands for Phlebotomy Technician. So, again, if you look in your, uh, in your book on page eight, table 1-1, you, uh, you're going to see that in there. All right.

Licenses, like I said, licenses are given by official state agencies. So, some states are, require that, some do not. So, here you don't need it. But if you go somewhere else, make sure that you, uh, find out if you are required to have that license.

Continuing education, of course. Um, once you are certified, it is important that you continue to, um, continue to learn more, of course, right? Continue because the medical field is always changing, and it is important that you continue your education, continue to read. So, it is required for you to do CEUs, which is continuing education units. And, uh, those units, you can get them from different, uh, organizations. Also, AMT and ACP, you can get it through them. You just pay a fee and you take those credit hours, and then it can just go directly to them, so they can give you credit. Or you can go through other different, uh, agencies and then ask them to send it to whoever is your certifying agency. And of course, the hospital giving you credits. So, that's what CEUs are, are basically it.

So, patient interaction. So, phlebotomy, of course. So, phlebotomy, as a phlebotomist, it is very, very important that you understand that you are the face of the lab. Okay? If you ask anybody, um, about the lab, I bet you that nine out of ten, the first thing they're going to say, oh yeah, the person that draws your blood, right? They're not going to say, oh, is the lab tech or, uh, that clinical laboratory scientist in the back or anything like that. They don't know that. They basically see the phlebotomist as the laboratory, right? So, you, as the face of the lab, make sure that you, again, are always professional, always courteous, um, make sure that you always are respectful because you are representing not only the phlebotomist, but you are representing the laboratory, and of course, overall, you represent that hospital or clinic. So, it's important that you, uh, understand that.

Recognizing diversity. As you know, the, we are a society with different ethnicities, different cultures, nationalities, different experiences, you know, beliefs and values. So, you just need to make sure that you are respectful, right? Respect everybody's opinion, beliefs. So, there are individuals that like to be very, very close to each other, and some individuals that want, you know, their bubble and be away from individuals. So, just make sure that you are, uh, aware of the individual. So, for example, like there's some individuals that say, well, I do not want anybody to touch me. If, for example, if he's a woman and they do not want anybody to touch him, just another woman. Respect that, right? Don't be offended. Say, okay, yeah, absolutely, ma'am. Not a problem. Give me one second. Let me go and get a female phlebotomist. Or or vice versa, if it's a male, say, well, no female is going to touch me. Understand that. Say, no problem. Let me go and get a male phlebotomist, right? So, just be, be conscious of that. Again, with the gender identity and expressions, again, just be respectful. There are, uh, individuals, right, that, uh, um, have their different beliefs, different, they express themselves differently. Just be respectful. I, I, I, I'm not here to tell you that change your perspective on on individuals. I'm just here to tell you that, you just need to be respectful, right? Respect everybody's belief, respect everybody's, uh, way of feeling. So, just be respectful. And let's say, what else? Now, I think that's it. The same thing with this, right? There are individuals that are going through, um, some surgical, some, uh, transgender. If you call somebody, uh, erroneously, just apologize, say, I'm sorry, and rephrase yourself again. Just treat people with respect, draw their blood, send them on their way.

So, qualities of professionalism. So, one of them, of course, professional appearance. So, make sure that when you get to the hospital, every hospital, clinic have their own policies on the way that you need to be dressed up, right? So, make sure you just follow the rules and and be as professional as possible in your appearance. You know, take showers. Nobody wants to be around somebody that's kind of stinky. So, just again, follow the rules, whatever they require. I know that it used to be that, um, some places, and again, that was long time ago, for example, no tattoos or something like that, and if you had a tattoo, you have to wear long sleeves. That's not the case in, uh, uh, majority of the places now. And as you're probably going to see, Professor Moody is going to tell you that it's not a big issue because he's full of tattoos. So, that's not a big issue now. But just giving you kind of an example how things have changed from before and now.

Self-confidence. Again, everybody knows what self-confidence is, able to, uh, trust your own personal, um, judgment, right? Make sure that you know what you're doing and capable of doing. So, again, like, for example, that that story I was telling you about the patient that, uh, didn't want a student to draw him, but I was self-confident. I know I can do it. I saw his veins, he had very good veins. I'm confident. I know I can do it. So, you know, that's, that's basically self-confidence right there.

Integrity. Everybody knows what integrity is. Make sure that you always do, uh, what is right, even if nobody's looking, right? Make sure that you, uh, have that integrity.

Compassion. Uh, as that's a big one, right? Like I said, a lot of the patients, um, are that that go to the hospital or are going through a lot of emotions, either because of the illness or whatever the case may be. So, make sure that you do have that compassion, make sure that you, uh, understand what they're going through and, uh, make them as comfortable as possible.

Self-motivation. Basically, that is you finding a way of of doing what it needs to be done, right, in order to perform the job as a phlebotomist. For example, one of the things that, uh, our clinics and hospitals that we work with, one of the things they basically tell us when the students go there is that, my goodness, you know, a lot of your students, they're like always very proactive. They, uh, making sure that the carts are always stocked, looking, make sure nothing is expired, you know, and things like that. So, that's basically self-motivation, you doing what it needs to be done without having somebody to tell you what it needs to be done. So, uh, please make sure you continue that. That's one of the things we hear a lot from, uh, these hospitals and clinics that our students are always, you know, self-motivated, and and that's that's a good thing.

Dependability, right? Make sure that you have very good work ethics. Make sure that you are always showing a constant and reliable effort to bring that your job value, right? That you are there to do a job and making sure that they can depend on you. If, if you need to be there at a certain time, that you're going to be there at a certain time, and that you're not going to be always creating excuses for not doing the job that you're supposed to be doing. So, uh, that's basically, uh, dependability.

Ethical Behavior. So, um, of course, ethics is moral principles or standards that govern conduct and distinction between what's right and wrong. So, just make sure that you always bring that ethical behavior and and and and always do what what is right, right? And, uh, making sure that you are not, uh, like I said, if you have to think about it, like, should I do this or not? More likely, you shouldn't do it, because just having you to think about it, it is, uh, basically telling you, maybe I shouldn't do it. So, just, you know, make sure that you do everything that it is right. And of course, if you have any questions about something at work, make sure you ask, like the supervisor, uh, in order for you to try to get to the right answer.

Let's see. Patients' rights. So, as you know, the patients have rights by fair law, and states have also, uh, laws that protect the patient information. So, make sure that you follow all those, um, rules. So, right for privacy of medical records. So, the patient has the right for, uh, to obtain, uh, their medical records, a copy of their medical records. But again, that doesn't mean that just because they have a right for that, that anybody can just give it to them. So, for example, let's say that, uh, a patient goes in the morning for a pregnancy test, right? And then that afternoon, they go and say, okay, I was here this morning for a pregnancy test. I just want to know what the results are. You are not authorized to give out those results, right? So, but, but you say, no, you're not basically telling the patient, no, no, you cannot know about what's going on with you. You basically are saying, I'm, I'm not authorized to give you that result. But if you go back to your doctor or to the nurse, you know, they should be able to give you those results. Or if they go, for example, to, uh, the medical records, right? They, they go there and they sign some waiver or whatever, and they'll give them a copy of their medical records. But you, as a phlebotomist, are not authorized to be giving out medical results, okay? So, make sure that you know that.

All right. Continuing patient rights. American Hospital Association, uh, of course, that one, it's all about the patient care partnership that provides high-quality hospital care, make sure that the area is clean in the hospital, to improve the patient care, protections of privacy, and so on, so on. So, it's just an agency that, you know, helps, uh, promote the patient care, uh, partnership.

Confidentiality. Patient information must be kept private and confidential. This one, of course, is a big one. Everybody knows about HIPAA, the Health Insurance Portability and Accountability Act, right? Which means that you want to protect the health information of any patient, right? So, one of the things is, a lot of times, healthcare providers, they're discussing certain patients' issues or, uh, patient information, you know, among themselves. But at the same time, they need to be very careful with the things that are being said, because just because they don't say the name of the individual, that doesn't mean that they are not violating the, the HIPAA, okay? Because, let's say they're, they're talking about, I don't know, a very rare illness, right? And these two doctors are discussing, you know, the patient that has this, blah, blah, blah, blah, these and that. They didn't mention no name, but if another individual knows this patient that they're talking about, because they, you know, they were able to get a clue about who they're talking about, that's automatically violating that, um, you know, HIPAA. So, just be careful where you talk about patients. If you have to discuss something about a patient, make sure it's done in the proper area, and not like break rooms or down the hall or things like that, okay? So, that's, uh, very, very important that you're able to recognize where you should talk about, uh, patient information.

Communication skills. Of course, uh, make sure you're able to communicate with patients. Like I said earlier, some patients, uh, would not speak English, and and it's sometimes difficult to, uh, communicate with them. I believe, uh, one of the other professors, Professor Lester, was talking to the students. He said that, one time, uh, when she was, uh, going to school and things like that, she was talking to a patient about to draw the blood or something, and the patient was just saying yes, yes, and she will ask a question, and the patient would just say yes, yes, yes, and everything was yes. But because the, basically, they were asking her the patient open-ended questions, like, you know, like just yes or no. But sometimes it's important to ask a question that is more than just a yes, so you can understand and and make sure that the patient is is understanding what you are talking about or explaining to them. So, it's is very important there to exist that, uh, communication, you know.

Interpersonal communication components. Again, verbal, active listening, nonverbal. Again, one of the nonverbals is what, like, uh, shaking the head yes, no, you know, things like that. Nonverbal body language, right? Or or shaking or being nervous or crying, things like that are nonverbal body languages that you also need to be aware of. A quick story on that personal too is, um, you know, in the military, it was, it was customary that soldiers had to have like an HIV testing every year. And this soldier came, and she needed an HIV test. So, I said, okay, yeah, no problem. Have a seat, you know, I'll draw your blood and send it. But, um, one of the things I noticed was that she was, you know, shaking and she was crying and everything. And I said, okay, maybe, you know, the patient is afraid of needles. It happens. Some patients are afraid of needles, and they start, you know, kind of crying or shaking and things like that. And I said, it's going to be okay. Are you afraid of needles? And she's like, no, no, no, I'm okay with that. And I'm like, okay, are you all right? Are you, you feel okay? And that's when the patient basically just said to me, well, I, I just found out that my, um, my boyfriend is HIV positive. So, at that moment, I was like, oh, wait. I was assuming that she needed the HIV testing for the military, right? I mean, that's that's a common thing, like I said, to do. But she actually needed a medical HIV testing because her boyfriend came positive for HIV. So, what I had to do was to basically start what I was doing as, say, give me one second. I called a nurse, you know, told the nurse what happened and everything, and the nurse basically took the patient with her to see a provider so they can go through the right procedures and everything that she needs to be done. So, again, make sure that you always pay attention to all these things.

Again, verbal communication. There are some barriers, again, culture, gender, language, age, physical issues, things like that. So, make sure that you understand those barriers and that if you need an assistant for that, make sure you get that. For example, language, like I said, that's one of the main ones, right? We do have people from all over the world here. And if you need somebody, I believe a lot of hospitals have these that you can call this number and request an interpreter, and they'll get you an interpreter so you can, you know, be able to communicate with the patient. So, make sure you're able to recognize these barriers and and overcome them.

Elements of effective healthcare communication. Again, empathy, right? Control, trust, respect, and confirmation. Those are very, very important to have in order to, uh, fulfill your job. So, make sure you keep those in mind.

Let's see. Telephone communication. Again, make sure that you, when you answer the phone, when the phone rings, make sure you're always polite. Make sure you identify yourself, and make sure you tell them, you know, where they're calling, you know, for example, "Good morning, thank you for calling, uh, I don't know, Scott and White Lab, Tori. This is Hi May. How can I help you?" So, right? A lot of times, they probably are calling to the wrong number, okay? And I'm not going to lie, sometimes you get frustrated. Let's say that the hospital decided to change the numbers between the radiology and lab, right? And all of a sudden, they're calling you because they want to make an appointment for radiology, and you know, they're calling you. So, um, sometimes you can get frustrated. You can get frustrated, right? That, oh my God, why did they keep calling, keep calling, calling? Well, it's not their fault, it's not your fault. You know, just make sure that you send them to the right location. Say, "I'm going to transfer you, ma'am," and this is the number in case we get disconnected. And over time, as people start getting the new number, it's going to stop. But at the beginning, it can be a little frustrating, frustrated to constantly be, you know, transferring or or getting all these calls that don't belong to you. But just make sure that you're always polite and, uh, help out.

I, again, these are the proper telephone etiquettes. You can read them yourself. So, handwritten communication must be legible and written in ink. So, nowadays, and we will talk a little more also about, uh, blood orders and things like that from providers. Nowadays, everything is done on computers, okay? They send the order through the computer, they do things through the computer. Also, when you need to send the patient with a test that they need to do on their own at home, sometimes you can send them emails, I believe some hospitals will send them emails with instructions. But you also have a piece of paper with those instructions. Make sure that piece of paper you're giving them, it's, uh, clean, it's clear, and and accurate, you know, because sometimes, worker or employees will just go and make copies and copies and copies and copies and copies of of those documents, and without actually knowing that there was an updated version, right? And they're like, oh, we just make copies. Well, you need to make sure that those documents that you give out have the right information. So, when you're just making copies, make sure there's nothing out there that's being, you know, um, updated or things like that. Also, a lot of times, when you just make copies of a copy of a copy of a copy, it can get a little messy. So, make sure that that document is clear and there is, is, uh, legible, you know, and patients can read it. One of the other things too is that even though you're sending the patient with that document, I'm not going to lie, and you probably know this because you're also being a patient, right? A lot of times, they don't read it. So, one of the things I like to do is, basically, tell them, right, the procedure, but also give them those documents so they can do it at home. So, when they're reading it, they kind of also thinking of what you basically told them. They're like, oh, okay, okay, okay. Because, yeah, a lot of patients, um, are not going to read those instructions. So, make sure you also verbally tell them, okay?

Healthcare delivery. So, there are three levels of healthcare delivered in the United States. We have the primary care, secondary care, and tertiary care. So, for example, the primary care, everybody knows, right? The primary care is your primary care provider, your physician, your nurse practitioner, that doctor you always go to whenever you get sick. Secondary care will be more of a specialist, like, for example, a cardiologist, an endocrinologist, somebody that specializes on a specific area, right? Tertiary care is a more highly specialized office of, like, for example, like a burn unit, right? Or the, what is this name, MD Anderson Cancer Center, right? They specialize on something in a specific area, and that will be more like tertiary care. That sometimes that cardiology will say, you know what, you need to go to this other place because that's the best in in in in this area, and they'll be able to help you a little further. So, that will be more like tertiary care.

The two general categories of facilities, again, ambulatory and non-ambulatory. Ambulatory means that they're outpatients. That means they're ambulant. It means that they can move, they can go in and out, right? That's an ambulatory. Non-ambulatory will be inpatients. So, that will be like individuals that are in the hospital, that are in a ward, right? Those will be considered non-ambulatory. And medical specialties, please, again, text table 1-8, you can find more information about those, and we're not going to go into too much detail on those. You can go in there and check them out.

All right. Ambulatory care. So, ambulatory care, basically, you can provide that in different types of settings, like, uh, certain hospitals have, uh, clinics, or or, of course, they have the phlebotomy room in which patients just go in, get their blood drawn, get out. Some treatment facilities also have those. The homebound services, those basically are for like patient homes or long-term care facilities, in which you actually go to either the patient's home or a long-term care facility to go and draw the blood and then take it back with you to the hospital to be processed or whatever the case may be, or send it to whatever it needs to be sent.

Public Health Services, PHS. So, this is a department that falls under the HHS, Department of Health and Human Services. Their mission is to protect and advance the national, uh, nation's physical and mental health. They basically sponsor different things like the development of health resources, the prevention and control of diseases, dealing with drug abuse. Um, they're constantly monitoring and screening, um, you know, all this information in order to educate and and protect the public, right? So, for example, if somebody comes in with a, uh, a very contagious disease or something, right, it gets reported to them so they can, you know, do the investigation and then, of course, inform the population and do whatever they need to do. They also provide services at a very low cost or free to the entire population.

The Affordable Care Act, ACA, also a lot of people know it by Obamacare, basically guarantees access to healthcare by preventing denial of coverage due to pre-existing conditions. So, that is another, uh, policy care out there for, uh, patients.

Third-party payers, that is like an insurance company or a federal government or somebody that will make a payment to whatever, uh, facility for, uh, on behalf of a patient for receiving some type of care. This is alternative to direct payment, also known as self-pay or out-of-pocket pay.

Diagnosis and billing codes. So, that is the CPT. The CPT is used to classify, report, and bill for the variety of, uh, healthcare services. So, it is a, the terminal being used in order to bill these insurance companies and also to code the diagnosis and keep it in the patient's record. And of course, on text, table 1-7, you'll get, uh, a little more information there in the book. And that is table 17, that's on page 22. You'll get a little more information on that.

All right. Reimbursement. You either have, uh, Medicare and Medicaid. Of course, Medicare is for individuals that are over the age of 65, or and have, uh, certain younger individuals that that have a, um, a disability or are receiving like dialysis. Medicaid, that is, uh, for, uh, assistance program that serves low-income families and, uh, individuals.

The Accountable Care Organization, ACO, is a, is a basically a network of hospitals, physicians, and providers that share information. And the intent is to improve the quality of care and reducing the cost by reducing those duplications and things like that.

So, Managed Care. Managed Care is basically a payment system that attempts to, um, manage the cost, the quality, and access to, uh, healthcare. And that's basically what it does. It's it's making sure that the cost stays low, and that's by, uh, reducing the unnecessary, um, you know, expenses in the medical field. So, for example, if you need to go and see, uh, a different type of provider, specialist, you know, you have a PCP that is the like the gatekeeper. They control that the referrals and who needs to go and things like that. They also, um, uh, do pre-authorization, like I said, for certain medical procedures and designate a case manager that is is managing all the necessary, um, procedures of of your care or or the patient. Again, same thing, case manager from primary care providers as a gatekeeper. So, and so on.

So, you also have the Managed Care Organizations, MCOs. You have the HMOs and the PPOs. So, the HMOs, the Health Maintenance Organizations, they it's like a group of practices of doctors, right? That are within in-network. And you, in order for you to, like, go and see a specific doctor, whatever it has to be in-network. You cannot just go and see, uh, a specialist without like them referring you there, because if you do, then you will end up paying out of pocket because it was not in-network. The PPOs, Preferred Provider Organizations, also, independent groups of physicians and hospitals, um, that, you know, they're also kind of like get in-network. They, they communicate with each other. But the difference is that on this one, you are not required to get like a referral. You can just go and see them. Of course, this type of premium is a little more expensive because you're not required to get a pre-approval before going and see these, these specialists. That's the main difference between, uh, those two.

The, uh, Clinical Laboratory Services. So, what is the Clinical Laboratory Services? They perform the tests on patients and specimens. They test for diagnosis that can help the provider and to evaluate and monitor the patient's medications and condition. The clinical lab, typically, every hospital has one. But there's also reference labs. And those reference labs are more for unusual testings that needs to be done. Common testings like chemistry, CBC, they're done usually in the hospitals. They have the instrumentation to do. But, for example, like lead poisoning and things like that, other more tests that are not as frequent, they basically send them to a reference lab. And the reason because it's more cost-effective, right? Let's say that the instrument to

Run, uh, lead poisoning. It, it's very expensive, and how often they're going to be doing, uh, lead testing poisoning in in the hospital? Not that frequent, right? So to spend all the money on instrumentation they're not going to need by just maybe once a year is not cost-effective. So what they do, they send it to this reference lab, which the reference lab basically gets hundreds of different, um, uh, lead poisoning testing from all over the United States, you know. And that's more cost-effective for them because they're going to be running that test more, more frequent.

Uh, also, you know, they have point-of-care testing, uh, makes testing services available to many, uh, locations, different clinics that are, uh, do not have the access to to those big instrumentation. So they have these small instruments that they can do, uh, a point-of-care testing in their facility.

In the laboratory, of course, you have the laboratory director/pathologist. Uh, usually the director, it is a, uh, pathologist, right? He is the, uh, medical doctor. Uh, they basically manage the lab, uh, along with lab administrators. Um, and they can either be a pathologist, which I said, a medical doctor, or they can be a clinical laboratory scientist with a doctor degree. From my experience, every hospital I work with, the director is always being a pathologist, a medical doctor.

For the laboratory administrator or lab manager, uh, we usually just call them lab managers. Uh, those are usually, uh, you know, clinical laboratory scientists, um, that have an advanced degree, right? Or have a lot of experience. They've been lab managers for, uh, or I'm sorry, they've been clinical lab scientists for many, many years. So, uh, they probably have maybe a bachelor's with a lot of years' experience or, or, or at least a master's. Um, and those are the ones that usually run the lab, uh, day by day. What I mean run it, I mean like, you know, making sure that every, every section in the lab, the supervisors are, are taking care of, uh, whatever section is to be taken care of, and if there's an issue, he can jump in and, and help, uh, solve whatever situation is going on.

Uh, technical supervisor. Again, these ones are supervisors for different areas of the laboratory, and, and I believe in later on in the slide, I show you the different, uh, areas of the laboratory. But I'm talking, uh, like for example, uh, chemistry supervisor. Uh, she will be the technical supervisor for that area. Anything that is involved in the area of, of, uh, chemistry, um, that supervisor will be responsible. Uh, hematology, let's say, uh, blood banking, microbiology, all those areas have their technical supervisors.

The MT, uh, medical technologist or medical laboratory scientist, MLS, or sometimes they're also called CLS, Clinical Laboratory Scientist. Typically, um, they have a bachelor's degree, all right? And they basically perform all the levels of testing in the areas of the lab. Uh, they can also be like the lead techs, you know, uh, on a specific area. Um, so they also perform quality control, evaluate procedures. If, if, uh, an instrument is, uh, uh, putting out, I don't know, some erroneous results or something, they're the ones that go there and find out what's going on, change the parameters, or whatever it needs to be done. Uh, they can also do maintenance on instruments, uh, and fix whatever needs to be fixed.

The medical laboratory technician, MLT, or sometimes also called as Clinical Laboratory Technician. Typically, it is an associate degree. So the difference between the, uh, MLS and the MLT is again, a bachelor's degree and associate degree. And those are the ones that, uh, perform routine testing, you know, everyday testing. They run controls, they run the tests. They are the ones that also do some of the maintenance on the equipment, on the instruments. Uh, so they're the basically the day-to-day, uh, technicians for performing testing.

The medical laboratory assistant, MLA, Clinical Laboratory Assistant, CLA. Um, that one is like a phlebotomist with a little bit more skills in the specimen processing area and the basic lab testing. Uh, they can assist, uh, the MLS or the MLT in any area, but they need to kind of like be, um, uh, basically overlooked by one of them, right? I mean, uh, they can perform some testing that are, uh, waived testing. We'll talk a little more about that, but they can basically help a little more in the area than just, uh, doing phlebotomy.

And of course, uh, last but not least, is the phlebotomist, right? The phlebotomist collect the blood for the tests. They're the ones that, um, uh, making sure that they, uh, the labs are, uh, drawn in the right order, that they are sending them correctly to the lab, that, uh, nothing is wrong with those specimens. And of course, uh, what type of education they need? Well, they need at least a high school diploma or equivalent to enroll into a phlebotomy program or type of certification.

Other types of laboratory personnel, of course, you have the laboratory information system, which they call the LIS. Lis, uh, and they basically are the ones that are the IT of the lab. They are the ones that make sure all the instrumentations and the computers are basically talking to each other.

Quality, uh, uh, quality and compliance coordinator, QA/QC coordinator, also known as QA/QC coordinator. They are the ones that are making sure that the quality control, the quality assurance that the, uh, in the whole, um, uh, CL, uh, sorry, in the whole laboratory, um, it's, it's being followed, okay? They are the ones that, uh, making sure that we're putting the right results and, and things like that. Uh, we'll talk a little bit more in, I believe, in chapter two about QA/QC.

Point-of-care supervisor. Uh, those are individuals that, uh, uh, making sure that those instruments that are out there, they are not necessarily in the lab, but they are out there in the different clinics or the different, uh, wards, like the, I don't know, women's health or pediatrics, whatever those point-of-care instrumentations are. They are the ones that, uh, track all that and making sure that those individuals that are using those instrumentations are being trained and making sure that they're doing what they're supposed to be doing.

Uh, of course, educator coordinator, making sure everybody is being trained and educated in whatever areas they need to be, uh, you know, trained on.

Uh, supervisor support services. Uh, a lot of times, those are the ones that are in charge of making sure that any other service that the laboratory needs, uh, it is being received by these other services.

Now, the traditional clinical laboratories, we're looking at, um, clinical analysis areas, right? Also the anatomical and surgical pathology areas. And, um, these areas, uh, are divided into different sections. And let me see, I believe it's the next slide. Yes.

So on this, uh, basically, uh, see the Department of Laboratory Medicine and Pathology. Sometimes it's also called the Department of Pathology and Laboratory Services. And it breaks it down, uh, into different, uh, categories. You have the, uh, anatomical and surgical pathology. This one involves the histology, cytology, and surgical pathology. Supervisor. Point-of-care, like I said, nursing care, outpatient services. Blood bank, transfusion medicine. In chemistry, we have toxicology, TDM, therapeutic drug monitoring, molecular diagnosis. Hematology, we have coagulation, immunology, urinalysis. Microbiology, we have bacteriology, mycology, virology, parasitology. And of course, the flow cytometry. We have these ones here, and they're the different departments of it.

Okay. So, for example, in chemistry, what does chemistry, um, do? Where they detect and measure chemical substances in the body, right? They, they, for example, uh, the electrolytes or, uh, your cholesterol, your sugar, you know, glucose, and, uh, amylase, and so on, so on, different tests. Uh, what type of, um, uh, specimen tube they require? The majority of the time, it's, uh, gray top. The gray tube is used for doing glucose or also alcohol. And of course, you have the, the green top. And the green top is being used for a lot of the chemistries like, uh, uh, CMPs, uh, complete metabolic panel, BMPs, basic metabolic panels. Um, now, they don't have it here, but they also use the, the red top. Okay. What is the difference between the red top and these ones here? Well, these ones have anticoagulant, and we'll talk about that. What is an anticoagulant? Well, the anticoagulant gives you plasma, okay? Uh, while the red top gives you serum. And of course, you're going to need to know that that's going to be testable and of course, part of your job to know that too.

So, hematology is the study of blood and and forming, uh, tissues. But, uh, basically, they look at the different cells, white blood cells, red blood cells, uh, the morphology of them, and platelets, and all that. What type of tube they use? Well, they, uh, use the lavender top, which you see it here, or this type, either or. That is the preferred tube for hematology. You definitely need to know that. What do we call this test? This test is called the CBC, the complete blood count. CBC uses the purple top.

Okay. Then we have the coagulation, where it identifies and monitors defects in the blood clotting mechanism. Of course, you know, uh, when your blood clots, it goes through different types of factors, clotting factors, which of course, we're not going to discuss this in this class. That's more for MLT. But what you definitely need to know is that coagulation, the tube they use is the blue, blue top or light blue top. One of the, uh, common tests on this is PT, INR, or also, uh, the COA, an analysis, APT are the most common ones. And of course, you definitely going to need to know that.

Okay. In immunology and serology, so this is identifying antibodies and antigens. Again, they use, um, the red tube or the, uh, yellow tube. And again, these ones give you serum. That's why serology, right? Serum tubes because this one do not contain any type of anticoagulant. So what's going to happen is that these tubes, you have to wait until the blood clots and then you can spin it down to separate the red blood cells and that clot from the, uh, serum. Um, and when, when we're in class, I will explain what this gel means on these tubes. Some of these tubes contain gels, and I'll talk a little more about it in class. But basically, what it does is once it clots and you spin it down, when you separate that clot, those red blood cells, it's going to push them to the to the bottom, and this gel is going to come to the top. So it's going to separate the clot from the actual serum. So in case that the tube falls down or something, right, it's not going to remix again. It's going to, uh, keep that separation.

Microbiology, of course, we have these, um, uh, blood culture tubes that you can, um, um, collect, uh, directly from, uh, the venipuncture. And again, we'll talk a little more, uh, in the lab about how these ones are used and, and all of that.

For blood bank or immunohematology, right? Prepare blood for transfusion. This is what they're going to be sending to the, um, blood bank in order to get tested to see what type of blood type the patient is and to request blood for transfusion. Uh, this pink top, it is an EDTA tube, which is the same anticoagulant as the purple tube. Okay. So sometimes students ask, so why can't we just use the purple top if it's the same anticoagulant? Well, you can. All right. The main difference between why this one is pink and the other one purple is because again, it's all about, uh, the, um, being able to recognize importance. A CBC, I'm not saying it's not important, but a lot of times it can be routine. But when, uh, a technician sees this pink top, right, automatically knows that it is, uh, a a a tube that needs to go to blood bank to do a transfusion and that needs to be run quickly. So imagine if you have two purple tops and one is just a CBC and the other one is supposed to be for blood bank. If the technician is not paying attention because it's busy and things like that, and he sees two purple tops, like, okay, I'll take care of them in just a minute. Well, that's not good, right? Because this one needs to be processed immediately because more likely somebody's at the ER waiting for that blood to be transfused. So, um, that's the pink tube.

Uh, of course, uh, little, I'll show you in class, uh, about like a urinalysis, what type of tube or what type of, uh, tubes they use and things like that.

Toxicology, genetics, flow cytometry, and molecular, they use other types of, um, the specimens that, of course, we'll talk about a little more in, in, in lab, in the actual class.

So, medical laboratory scientist. Love. This is just an example of how a, uh, MLS is loading the samples in this instrument over here.

Histology and cytology. Well, this, this is basically the main area of Professor Moody. He is, uh, certified as a cyto, uh, in histo, I believe, or histo. Um, and histology is an area where they evaluate the tissue samples, you know, they do biopsies, they, they cut them, they put them in these slides, right? And then read them to determine if there's any type of malignancies. And that's the histo part. So this one basically gets the tissue, puts them in slides, bunch of stains, different things, and then they send it to cytology. Cytology looks at them, and they're the ones that basically determine any type of malignancies from those cells or anything that needs to be done. If they see something, they, they send it to the pathologist to finish the interpretation. You know, if everything is looking normal, then, you know, they just say everything is normal and just carry on.

Satellite reference laboratories. Satellite laboratories. Um, like I said, some, some areas have like their own lab. For example, there was a time in which a big medical center had a, a main lab, but a lot of times when they were sending samples from the ER, even though they were stat, and remember, stat means it has to be done within one hour, sometimes it was passing that hour because the main lab was receiving quite a bit of of load from all the wards and everything. So what they ended up doing, they actually created a small little lab just for the ER down there in the ER. Again, that lab belonged to the main lab, but it has its own lab, and that way that technician was able to process anything that the ER was putting. And that's because again, it was a big medical center, and of course, they will receive a lot of patients in the ER plus whatever patients they had in the actual inpatients and outpatients coming through there.

The reference laboratories, like I mentioned before, they are large, independent labs. They receive specimens from many, many different facilities around the city, the state, the region, United States, I mean, from all over the place, right? And, and a lot of times they, they, they specialize in specific testing. So that's basically what they do too. Um, often they, they're fast in the turnaround times because again, uh, I, I never been to one, but I had a friend that used to work in them, and they say they have hundreds and hundreds of instruments there, so they're constantly working and in the turnaround. So they basically process those samples pretty, pretty fast. But, but basically, that's what the reference laboratory does.

Okay. That is it for chapter one. If you have any questions, feel free to ask them in class next time we see each other, or send an email, or, um, uh, or what are those, uh, texts on the, um, grouping? All right. Have a good one, guys. Bye.