Reporting and Communication

Every value you release and every conversation you have about it becomes part of the patient's laboratory record, and in Canada that record is discoverable, auditable and long-lived. You are expected to enter results into the laboratory information system accurately, attach any comment that changes how the number should be read, and capture telephoned or verbal communications with the same rigour — who you spoke to, when, what you said, and their read-back. Corrections are amendments, never erasures: the superseded value stays visible with a reason and a timestamp so that anyone reviewing the chart later can reconstruct exactly what the clinician knew and when.

Results do not arrive out of nowhere; they come out of a specimen and an instrument, and both can misbehave in ways the printed number does not show. You are expected to note what you see as you see it — turbid or icteric serum, a partial fill, a fibrin strand, a drifting baseline, an aspiration alarm, a reagent lot swapped mid-run. These notes go into the run record or maintenance log at the time, with a timestamp and what you did about it, not reconstructed at shift end. When a result is later questioned, contemporaneous observations are usually the only thing that explains it.

The centrifuged specimen shown arrives for a routine chemistry panel from a non-fasting outpatient. The panel is analysed successfully and all values fall within reportable limits. What should the technologist do about the appearance of the sample?

AReport results plainly; the analyser flags itBRecord the appearance and add an interference noteCDiscard the specimen and record only the rejectionDNote the appearance in a personal bench notebook

Partway through a batch, a technologist sees air bubbles passing through the reagent line of an analyser, primes the line, and the run continues normally with acceptable quality control. When should this be documented?

ARecord it at shift end if results are acceptableBTell the next shift verbally during handoverCLog it as it occurs, with time and actionDReport it only if a rule is later violated

Releasing a result and communicating it are not the same act. You are expected to know which results can simply be posted to the chart, which must be telephoned, and how urgently — and then to reach a person who is licensed and able to act on the information, not merely someone who answers the phone. Read-back confirmation is standard practice for anything communicated verbally. When only part of a panel is ready and the clinician needs it now, you release what is verified as a clearly flagged preliminary report rather than holding everything or communicating informally.

A request is not finished when the specimen is analysed; it is finished when every ordered analyte has either a reported result or a documented reason why there is none. You are expected to work the pending or incomplete list before handover, chase orders that have quietly stalled — insufficient volume, a cancelled add-on, a specimen still sitting in a rack — and make sure each one is either resolved or handed over explicitly. Silent gaps are dangerous because the clinician usually assumes no result means normal, or does not notice the absence at all.

Some findings automatically trigger further work, and some of that work happens elsewhere. You are expected to recognise the triggers written into your laboratory's protocols — a screening immunoassay needing mass spectrometry confirmation, an abnormal electrophoresis pattern needing immunofixation — and to initiate that testing without waiting to be asked. Where the assay is performed at a reference centre, you prepare the aliquot to the receiving laboratory's specifications, label and package it correctly, supply the clinical information they need, and log the referral so the specimen can be traced. Responsibility for the final report normally stays with the referring laboratory.

The densitometry scan shown was produced from a serum protein electrophoresis on a 68-year-old patient with back pain and anaemia. A discrete band is present in the gamma region. Under a standard laboratory protocol, what happens next?

AReport the scan and await a new clinician requestBRepeat the electrophoresis on a fresh specimenCReflex to immunofixation per the lab protocolDRefer the patient for a bone marrow examination

A specialised hormone assay is not offered in-house and the serum aliquot must go to a provincial reference centre. What handling of the referral is correct?

ASend it unlabelled with the requisition attachedBLabel, log, and record the referral centreCSend it and let the reference centre report directDSplit it and hold the referral off the patient file

When something goes wrong — a released result from an out-of-control run, a mislabelled tube caught at the last moment, a chemical spill, an exposure incident — you are expected to raise it promptly through the laboratory's formal reporting channel rather than handling it privately. That means notifying the supervisor, filing the incident or near-miss report, and taking whatever immediate containment action is needed, such as recalling affected results. Near misses count: an error caught before it reached the patient still reveals a weakness in the process. Reporting systems are for learning and correction, not blame.

A technologist notices that two specimens were loaded into the wrong rack positions and catches the mix-up during verification, before any result leaves the laboratory. Using the classification pathway shown, how should this event be handled?

ANo report needed; the patient came to no harmBRecord it in the bench log and take it no furtherCFile a near-miss report in the incident systemDRaise it only if the same error occurs again

Reviewing the previous shift's work, a technologist finds that patient results were released from an analytical run in which the Level 2 control had failed and was never repeated. What is the appropriate response?

AWait for the next QC run before saying anythingBCorrect the results quietly and say nothingCNote it and mention it at the next staff meetingDTell the supervisor and recall the results

Some patients need an assay that no community laboratory performs — metabolic screens, rare enzyme assays, specialised endocrine or toxicology work — and the laboratory's job is to get the specimen to a centre that can make the diagnosis. That means knowing which centre accepts the test, meeting its requirements for specimen type, volume, additive, protection from light and temperature during transit, and supplying the clinical history and medication details the receiving laboratory needs to interpret the result. Packaging must satisfy transport of dangerous goods rules, and the dispatch is logged so the specimen remains traceable end to end.