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Hematology

Customer Service

In the context of the clinical laboratory, customer service is not merely a soft skill; it is a critical component of Quality Assurance and patient safety. The laboratory scientist acts as a consultant to the medical team, and the efficacy of laboratory data depends heavily on how effectively that data is communicated. Excellent customer service reduces medical errors, improves turnaround times, and ensures that the laboratory is viewed as a vital partner in the diagnostic process rather than a bottleneck

Identifying the Customer

To provide effective service, the laboratory professional must recognize the diverse range of individuals who rely on their work. In healthcare, the “customer” falls into two distinct categories:

  • Internal Customers: These are the healthcare professionals within the organization who utilize laboratory services to treat patients
    • Physicians/Providers: They require accurate data and consultation regarding test interpretation (e.g., explaining why a platelet count is falsely low due to clumping)
    • Nurses: They are often the primary interface for specimen collection and result reporting. Service to nurses involves clear instructions on collection requirements and timely notification of delays
    • Hospital Administration: They rely on the laboratory for efficiency, cost-control, and regulatory compliance
  • External Customers: These are individuals outside the hospital organization
    • The Patient: The ultimate customer. Even if the laboratory scientist never meets the patient face-to-face, every tube of blood represents a human life. Service to the patient is defined by accuracy, timeliness, and the respectful handling of their biological material
    • Family Members: In outpatient settings, families often interact with phlebotomy staff
    • Reference Laboratories and Insurers: Entities that interface with the lab for billing or specialized testing

Communication Standards

Effective communication is the foundation of laboratory customer service. Miscommunication is a leading cause of sentinel events (medical errors resulting in death or serious injury). Therefore, communication protocols are strictly standardized

Telephone Etiquette

The telephone is the primary link between the closed laboratory and the clinical floor. Interactions must be professional, concise, and accurate

  • Answering: Calls should be answered promptly (typically within 3 rings). The laboratory scientist must identify themselves and their department immediately (e.g., “Main Lab Hematology, this is John. How can I help you?”)
  • Tone: The environment in the lab may be stressful, but the tone used with the customer must remain calm and helpful. “Smiling while speaking” changes the inflection of the voice to sound more accommodating
  • Placing on Hold: Never place a caller on hold without asking for permission and waiting for an answer. In emergency situations (e.g., a Code Blue), the caller may not be able to hold

Active Listening & Investigation

When a physician or nurse calls with a problem (e.g., “Where are my results?”), the laboratory scientist must practice active listening to understand the root of the issue rather than becoming defensive

  • Clarification: Repeat the patient’s name and Medical Record Number (MRN) to ensure you are discussing the correct patient
  • Investigation: Do not dismiss a query. If a specimen is missing, check the receiving area, the centrifuge, and the pending list. If the test was never ordered, offer to add it on if the sample stability permits

Managing Specimen Rejection

One of the most difficult customer service interactions in Hematology involves rejecting a specimen due to poor quality. This often places the laboratory scientist in conflict with the nurse or phlebotomist who collected it. The goal is to enforce quality standards without creating animosity

  • Educational vs. Punitive Approach: The notification of rejection should focus on the technical limitation, not the collector’s failure
    • Poor phrasing: “You clotted this sample, you need to redraw it.” (Accusatory)
    • Good phrasing: “I received the lavender top for Mr. Jones. Unfortunately, the instrument detects micro-clots which will give a falsely low platelet count. To ensure he gets an accurate result, we need a new specimen.” (Educational/Patient-focused)
  • Explaining the “Why”
    • Hemolysis in Coagulation: Explain that the lysis releases intracellular components that activate clotting factors, artificially shortening the PT/PTT
    • IV Contamination: Explain that the massive dilution by saline has produced results incompatible with life (e.g., Hgb of 4.0 g/dL with a normal MCV), and reporting it could lead to unnecessary transfusion
  • Documentation: All rejections and the subsequent notification (who was spoken to and at what time) must be documented in the LIS to provide a legal record of why the test was delayed

Critical Value Reporting

Reporting critical values is a mandatory regulatory requirement (CLIA/CAP) and a high-stakes customer service interaction. A critical value indicates a life-threatening state requiring immediate clinical intervention

  • Timeliness: Criticals must be reported immediately upon verification. Delays in reporting are considered a failure of patient care
  • The Read-Back Protocol: To ensure the message was received and understood, the person taking the result must repeat the information back to the laboratory scientist
    • The Scientist says: “Critical Platelet count of 10,000.”
    • The Nurse says: “I have a Critical Platelet count of 10,000.”
    • Confirmation: The laboratory scientist confirms “That is correct” and documents the read-back in the LIS
  • Barriers to Reporting: If the ordering physician cannot be reached, the laboratory scientist must follow the “chain of command” (e.g., contacting the charge nurse, the resident on call, or the pathologist) rather than giving up

Turnaround Time (TAT) Management

For the clinician, the speed of the result is often as important as the accuracy. Meeting Turnaround Time (TAT) targets is a service promise made by the laboratory

  • Proactive Notification: If a delay is inevitable (e.g., the Hematology analyzer is down for maintenance, or a difficult antibody identification is taking hours in Blood Bank), the lab should notify the ER or ICU before they call to complain. This manages expectations and allows clinicians to triage patient care accordingly
  • Stat vs. Routine prioritization: True customer service involves recognizing clinical urgency. A “Code Stroke” coagulation panel takes precedence over a routine morning round CBC

Service Recovery

Errors happen. Samples are lost, tests are missed, or incorrect results are released. Service recovery is the process of making things right after a failure to restore trust

  • Acknowledge and Apologize: When the lab is at fault, admit it. A sincere apology (“I apologize for the delay, the sample was misplaced”) diffuses anger more effectively than excuses
  • Amends: Fix the problem immediately. If a sample was lost, offer to send a phlebotomist to redraw it immediately so the nurse doesn’t have to
  • assurance: Explain what will be done to prevent the error from happening again (e.g., “I will file an incident report so our manager can review our receiving process”)

Professionalism & Ethics

Customer service in the laboratory is bound by ethical and legal constraints, specifically regarding patient privacy (HIPAA)

  • Releasing Information: The laboratory scientist must verify the identity of the caller before releasing results. Results should never be given to unauthorized persons (e.g., a patient’s employer or family member without consent)
  • Scope of Practice: Scientists provide analytical data, not medical advice
    • If a patient calls and asks, “My WBC is high, do I have leukemia?”, the correct service response is, “I cannot interpret the results for you. Please contact your physician who can explain what these numbers mean in the context of your health.”