Objectives

1. Define the key terms and abbreviations listed at the

beginning of this chapter.
2. Describe the evolution of phlebotomy and the role of the
phlebotomist in today’s healthcare setting.
Chapter 1: Past and Present and 3. Describe the traits that form the professional image and
the Healthcare Setting identify national organizations that support professional
recognition of phlebotomists.
4. Describe the basic concepts of communication as they
relate to healthcare and how appearance and nonverbal
message affect the communication process.

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Objectives (cont’d) Objectives (cont’d)

5. Describe the proper telephone protocol in a laboratory 9. List the clinical analysis areas of the laboratory and the
or other healthcare setting. types of laboratory procedures performed in the
different areas.
6. Demonstrate an awareness of the different types of
healthcare settings. 10.Describe the different levels of personnel found in the
clinical laboratory and how Clinical Laboratory
7. Compare types of third-party payers, coverage, and Improvement Amendment regulations affect their job
methods of payment to the patient, provider, and descriptions.
institutions.
8. Describe traditional hospital organization and identify
the healthcare providers in the inpatient facility.

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 Phlebotomy: A Historical Perspective
Phlebotomy: A Historical Perspective (cont’d)
• Stone Age • Middle Ages
– Crude tools used to cut vessels & drain blood from body
– Barber-surgeons performed bloodletting & leeching
• Egypt (1400 BC)
– Barber pole (red & white): represented blood of patient
– Tomb painting shows leech applied to patient for bloodletting
– Bleeding bowl: used to collect blood from patient
• Hippocrates (460-377 BC)
– Health depended on balance of the body. Thought disease was due to • 17th & 18th Centuries
excesses like blood, phlegm, black/yellow bile
– Phlebotomy became a major therapy
– Bloodletting was used to rid the body of evil spirits, cleanse the body.
– Lancets & fleams were used to cut veins & arteries
– Venesection: cutting vein to bleed patient
– Cupping & leeching were used

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Art of Cupping Leeching

• Process • Process
– Application of heated suction device, the cup – Place drop of milk or blood on the patient’s skin
– Incision with a fleam (lancet) – Introduce Hirudo medicinalis to the site that injects:
• Single or double-edged blade • Local vasodilator
• Multiple fleams attached & folded for ease of carrying • Local anesthetic
– Blades wiped clean with a rag, therefore disease was spread • Hirudin, an anticoagulant
from something that was suppose to help.
– Allow the leech to engorge and fall off

• Present day
– Used in microsurgical replantation

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Phlebotomy: A Historical Perspective
(cont’d) Goals and Methods of Phlebotomy Today
• Bleeding bowl, fleams, & leech jar • Goals
– Obtain blood for diagnostic purposes & monitor treatment (to
establish dosage, to maintain dosage at therapeutic level, avoid toxicity)
Example: blood thinner, seizure meds, mood stabilizers
– Remove blood for transfusions at a donor center
– Remove blood for therapeutic purposes: Therapeutic phlebotomy
(polycythemia (over production of RBCs, hemochromatosis (excess iron
deposits in the tissues)
• Methods
– Venipuncture: blood collection via a needle inserted in a vein
– Capillary puncture: blood collection via skin puncture

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Role and Skills of Phlebotomist Credentials

• Role • Certification
– Phlebotomist: anyone trained in blood collection – Certificate: document granted by agency
– Voluntary or may be required by facility
– Many healthcare team members are trained in phlebotomy
– Requires specific training & passing an exam
• Skills/Knowledge Needed
• Licensure
– Good manual dexterity
– License: official document or permit granted by state agency
– Special communication skills – Required by law
– Good organizational skills – Requires specific education, experience, & passing an exam
– Thorough knowledge of lab specimen requirements • Continuing Education
– Training in phlebotomy skills & standards of practice

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Patient-Client Interaction Qualities of Professionalism
• Customer Relations • Professional appearance
– Phlebotomist may be only contact patient has with lab • Self-confidence
– Patient may judge hospital based on encounter with
phlebotomist • Integrity
– Goal: put patient at ease & establish positive relationship • Compassion
• Diversity: Understanding patients’ health-related— • Self-motivation
– Beliefs & values • Dependability
– Needs based on environment
• Ethical behavior
– Customs & traditions
– Attitudes toward seeking help from healthcare providers

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Patients’ Rights Patients’ Rights (cont’d)

• Two documents published to strengthen consumer • AHA’s The Patient Care Partnership
confidence – High-quality hospital care
– The Patient Bill of Rights in Medicare and Medicaid – A clean & safe environment
– American Hospital Association’s The Patient Care Partnership – Involvement in your care
– Protection of your privacy
– Help when leaving the hospital
– Help with your billing claims

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Confidentiality Communication Skills
• Patient information must be kept private & confidential • Communication
– The means by which information is exchanged or transmitted
• Ethical standards & laws enforce confidentiality
• Components
• Health Insurance Portability & Accountability Act – Verbal
(HIPAA) – Active listening
– Safeguards confidentiality of protected health info (PHI) – Nonverbal (body language)
– Established national standards for electronic exchange of PHI • Kinesics: study of nonverbal communication

– States that patients must be informed of rights • Proxemics: study of an individuals concept and use of space
• Appearance
– Disclosure of PHI requires written authorization
• Touch: special type of nonverbal communication

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Duties & responsibilities of Phlebotomist Communication Skills (cont’d)

• Collect routine skin puncture & venous specimens for testing as required • Elements of Effective Healthcare Communication
• Prepare specimens for transport to ensure stability of sample
– Empathy
• Transport specimens to the lab
• Comply with all procedures instituted in the procedural manual – Control: patient’s sometimes need to feel in control of their
• ALWAYS maintain patient confidentiality
situation.
• Promote good relations with patients and hospital personnel – Respect & confirmation
• Assist in collecting & documenting monthly workload & recording data – Trust
• Maintain safe working conditions
• Perform appropriate lab computer operations
• Participate in continuing education programs
• Perform other tasks assigned by supervisory personnel

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Healthcare Delivery Healthcare Delivery (cont’d)
• Two general categories of facilities • Ambulatory Care
– Inpatient (nonambulatory) – Medical care delivered on outpatient basis
– Outpatient (ambulatory) – Patients requiring care after discharge from hospital

• Three levels of healthcare in the United States – Two types

– Primary • Freestanding medical care settings & hospital-owned clinics

– Secondary • Outpatient departments & urgent care facilities

– Tertiary • Homebound Services

– Patients’ homes
– Long-term care facilities

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Healthcare Delivery (cont’d) Healthcare Financing

• Public Health Service • Methods of Payment
– Part of Department of Health and Human Services – Direct payment
– Mission: to protect & advance nation’s physical & mental health • Patient pays provider
– Sponsors & administers programs on: – Indirect (third-party) payment
• Development of health resources • Insurance company, federal government, managed care
program, or self-insured company pays provider
• Prevention & control of diseases
• Dealing with drug abuse • Diagnosis & Billing Codes
– Constantly monitors, screens, protects, & educates public – Current procedural terminology (CPT) codes (see Table 1-5)

– Provides services for little or no charge to entire population • Reimbursement (entitlement programs)
– Medicare & Medicaid
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Managed Care Managed Care (cont’d)
• Definition • Case Manager
– A payment system that attempts to manage cost, quality, & – Is primary care physician & “gatekeeper”
access to healthcare by:
– Is experienced healthcare professional
• Detecting illnesses or risk factors early in disease process
– Coordinates all of patient’s healthcare
• Offering financial incentives for providers
– Knows patient’s condition & needs
• Offering patient education & encouraging healthy lifestyles
– Knows available resources for support & treatment
• Characteristics – Advises patient on healthcare needs
– Set fee schedule – Provides early detection & treatment for disease
– Preauthorization for certain medical procedures – Refers patients to appropriate specialists
– Designated case manager required

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Managed Care (cont’d) Organization of Hospital Services

• Network Service Systems • Characteristics of a “hospital”:
– Health maintenance organizations (HMOs)
– Permanent inpatient beds
• Group practices
– 24-hour nursing service
• Reimbursed on a prepaid, negotiated, & discounted basis
– Therapeutic & diagnostic services
– Preferred provider organizations (PPOs)
• Independent groups of physicians or hospitals – Organized medical staff
• Exchange discounted services for steady supply of patients • Hospitals are typically organized into departments or
– Integrated Healthcare Delivery Systems (IDSs) medical specialities
• Number of different types of associated medical facilities
• Offers cost-effective holistic and coordinated care

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Clinical Laboratory Services Clinical Laboratory Services (cont’d)
• Traditional Laboratories • Traditional Laboratories
– Clinical analysis areas – Anatomical & surgical pathology
• Hematology: blood & blood-forming tissues, most common test is a CBC (complete blood • Histology: the study of microscopic structure of tissues. Pathologist evaluate
count) samples from surgeries/autopsies to determine of they are normal or diseased.
• Coagulation: ability of blood to form & dissolve clots
• Cytology: Concerned with structure of cells. Cells in body tissues & fluids are
• Chemistry: Performs most lab tests. Most common specimen is serum. Can also use urine, identified, counted & studied to diagnose malignant & premalignant conditions.
plasma, other fluids. Most common is a pap smear for early detection of cancer cells.
• Serology/immunology: serology mean “study of serum”. Deals with bodies response to the
presence of bacterial, viral, fungal, parasitic infections.
• Cytogenetics: Found in larger labs. Samples are examined for chromosomal
deficiencies that relate to genetic disease.
• Urinalysis: Testing in this dept can be analyzed manually or with automated instruments.
Includes physical, chemical, & microscopic examinations
• Microbiology: Analyzes body fluids & tissues for the presence of microorganisms. Will tell
physician type of organism and most effective antibiotic.
• Physical: assesses color, clarity, and specific gravity. Chemical: screens for substances like
sugar & protein. Microscopic: establishes presence of blood cells, bacteria, crystals
• Bloodbank/Immunohematology: Prepares blood products for transfusions

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Clinical Laboratory Services (cont’d) Clinical Laboratory Services (cont’d)

• Stat Labs • A clinical chemist reviews stat chemistry results
– Established in some tertiary care facilities
– Located in emergency room
– For procedures & tests needed immediately

• Reference Laboratories
– Large, independent labs
– Receive specimens from many facilities in city, state, or region
– Provide routine & specialized analysis of blood, urine, tissue
– Offer fast turnaround times & reduced cost due to high volume

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Clinical Laboratory Personnel Clinical Laboratory Personnel (cont’d)
• Laboratory Director/Pathologist • Technical Supervisor
– Manages lab (along with lab administrator) – Administers a lab section or subsection
– May be a pathologist or clinical lab scientist – Reports to lab administrator
– Pathologist: a physician who specializes in diagnosing disease – Has additional education in one or more clinical lab areas

• Laboratory Administrator/Laboratory Manager • Medical Technologist/Medical Laboratory Scientist

– Usually a technologist with advanced degree & experience – Typically has bachelor’s degree plus study in MT program
– Oversees all operations involving physician & patient services – Performs all levels of testing in any area of lab & reports results
– May supervise ancillary services (radiology & respiratory – Performs quality control & evaluates new procedures
therapy)
– Maintains instruments

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Clinical Laboratory Personnel (cont’d) Clinical Laboratory Personnel (cont’d)

• A medical technologist performing a complete urinalysis • Medical Laboratory Technician
in the ER – Typically has associate’s degree
– Performs routine testing
– Operates & maintains all equipment

• Clinical Laboratory Assistant

– Has phlebotomy experience
– Has skills in specimen processing & basic lab testing
– Is a generalist; assists MLS or MLT in any area

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 Clinical Laboratory Improvement Act
Clinical Laboratory Personnel (cont’d) (CLIA ‘88)
• Phlebotomist • Allows regulation of all sites performing lab testing in US
– Collects blood for lab tests for diagnosis & care of patients • Mandates that all labs use same standards regardless of
– Often serves in role of lab assistant or specimen processor their location, type or size.
– Formal programs usually require high school diploma or • Sets requirements for:
equivalent to enroll
– Laboratory director
• Other Laboratory Personnel
– Technical consultant
– Computer programmers
– Supervisors
– Laboratory information systems managers (LIS)
– Testing personnel
– Quality-assurance managers
– Point-of-care coordinators

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Test Info Chapter 1: Past, Present, & The Healthcare setting

• What other department along with the lab coordinates for TDM?
• Be sure to know study questions as some are used on the tests
• What dept is responsible for administering O2 therapy?
• What does “phlebotomy” mean
• Know about different types of communication and communication barriers
• Know all lab departments and what they do
• Certification
• Patient client interaction
• Some of the first phlebotomists were who????
• Know your study questions
• Situation questions

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