Phlebotomy · Processing · 5 min read
Lab Information Systems, Critical Values and Result Reporting
- Explain the role of the Laboratory Information System (LIS) and accessioning in specimen tracking and data integrity.
- Describe the phlebotomist's responsibilities when handling critical point-of-care test values and urgent clinical notifications.
- Apply professional communication and privacy protocols when interacting with nursing staff, reporting specimen issues, and handling patient result inquiries.
The Laboratory Information System and the Accessioning Process
A Laboratory Information System is a specialized software application that manages patient demographics, laboratory orders, and specimen tracking. Within this software, the system tracks specimen status step-by-step through distinct stages, including ordered, collected, received, in-process, and completed. Authorized staff may be able to view these collection and laboratory receipt updates directly through the Laboratory Information System or a connected electronic health record. The software also maintains audit records of access and changes made to laboratory data in accordance with its specific configuration and facility policy.
Accessioning is the formal process of receiving specimens into the laboratory and assigning them a unique tracking identifier. This unique identifier is called an accession number; it may be numeric or alphanumeric and is assigned to a specimen or requisition in the Laboratory Information System. Through the accession number, the specimen or order is directly linked to patient identification and requested tests. Collection details and the collector's identity are also recorded as required by facility policy. Accessioning documents the laboratory's official receipt of a specimen and actively supports tracking throughout processing.
To ensure accuracy and reduce human error, barcode scanners are utilized during accessioning to read specimen labels and minimize manual data entry errors. In some healthcare facilities, radio-frequency identification technology can also be used for automated, real-time specimen tracking. If a specimen requires splitting, aliquot tubes must be labeled according to facility policy so that each individual aliquot remains traceable to both the patient and the original specimen.
The phlebotomist must verify patient identity and label the specimen at collection, then check that its identifiers match the order and that all other required label information is present; if assigned to accessioning, the phlebotomist checks the label again according to facility policy. If a specimen label and order do not agree, the phlebotomist must stop processing the specimen immediately and report the discrepancy for resolution according to facility policy. A phlebotomist must never process an unlabeled or mislabeled specimen as though it were properly identified; instead, they must report the problem and follow the facility's formal rejection or exception procedure.
| Technology | Primary Function in Accessioning | Key Benefit |
|---|---|---|
| Barcode Scanners | Reads printed specimen labels into the Laboratory Information System | Minimizes manual data entry errors |
| Radio-Frequency Identification | Enables automated tracking of specimens across the facility | Provides real-time tracking of specimen movement |
Common mistakes
- Failing to immediately stop and report when a tube label does not match the laboratory order, choosing instead to correct the label manually.
- Interpreting or explaining a point-of-care test result to a patient or family member rather than directing them to the facility's authorized release process.
- Relying on an unacknowledged electronic posting or leaving an unconfirmed message when a point-of-care result reaches facility-defined critical limits.
- Using a colleague's login credentials to document point-of-care testing, quality control, or critical result notifications.
Key points
- The Laboratory Information System manages demographics, orders, audit records, and specimen tracking from ordered through completed status.
- Accessioning assigns a unique accession number, which may be numeric or alphanumeric, linking the specimen or requisition to patient identification, requested tests, and required collection details.
- Critical values (alert or panic values) indicate serious risk and require prompt notification and confirmation rather than unacknowledged electronic posting.
- Phlebotomists authorized to perform point-of-care testing must verify that required quality control is acceptable, perform and document any quality control assigned to them under manufacturer instructions and facility policy, recognize readings that meet critical limits, and promptly report them without diagnosing or adjusting treatment.
- Urgent point-of-care reports must be communicated using required patient identifiers, verified for accuracy, and documented using the phlebotomist's own credentials.
- Phlebotomists must uphold privacy by withholding results from unauthorized staff, visitors, or family, and coordinating closely with nurses regarding refusals, timing, and rejected specimens.
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