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The review covers healthcare facilities, hospital classifications, patient rights, torts, clinical lab sections, lab personnel, phlebotomy history, and phlebotomist duties.

Classification of Hospitals (DOH) by Ownership:

Government hospitals are created by law and may be under national or local government, DOH, state universities, or colleges.
Private hospitals are owned, established, and operated with funds from donations, investments, or other means by individuals, corporations, associations, or organizations.

Hospital Organizations

Phlebotomists may be scheduled to work in various hospital areas or patients referred to the lab for sample collection.
Hospitals range in size from 50 to over 300 beds and vary in services provided.

Classification of Hospitals (DOH) by Scope of Services:

General hospitals are equipped to support board-certified or eligible medical specialists.
General hospitals provide clinical, emergency, outpatient, and ancillary support services.
Specialty hospitals may be devoted to treating specific illnesses or conditions.
They might focus on diseases of a particular organ or patient groups like children, women, or the elderly.

Functional Capacity of General Hospitals:

Level 1 hospitals have consulting specialists in medicine, pediatrics, OB-GYNE, and surgery.
Level 1 hospitals include emergency and outpatient services, isolation facilities, surgical/maternity services, and a dental clinic.
Level 1 hospitals also include a secondary clinical laboratory, blood station, 1st level X-ray, and pharmacy.
Level 2 hospitals include everything in Level 1, plus departmentalized clinical services and a respiratory unit.
Level 2 hospitals also include a General ICU, high-risk pregnancy services, NICU, a tertiary clinical laboratory, and a 2nd level X-Ray with mobile unit.
Level 3 hospitals include everything in Level 2, plus teaching/training with accredited residency in 4 major clinical services.
Level 3 hospitals also include physical medicine with a rehab unit, ambulatory surgical clinic, dialysis, a tertiary lab with histopathology, and a blood bank.

Hospital Services and Departments:

Four traditional services include Nursing, Support, Fiscal, and Professional.
Nursing Services deal directly with patient care.
Support Services include communication systems, food, and housekeeping.
Fiscal Services cover business aspects like accounting, admitting, data collection, and health information management.
Professional Services assist the physician in diagnosing and treating diseases.

Professional Service Departments:

Include Radiology and Diagnostic Imaging, Radiation Therapy, Respiratory Therapy, Nuclear Medicine, Occupational Therapy, Pharmacy, Physical Therapy, Cardiovascular Testing, and Clinical Laboratory.
The clinical laboratory provides data to aid in determining the diagnosis, treatment, and prognosis of a patient.

Physician Office Laboratories

Physician Office Laboratories consist of primary care physicians or specialists such as pediatricians or cardiologists.
They are comprised of family practice physicians and specialists.

Other Healthcare Facilities

Hospital Organizations
Physician Office Laboratories
Health Maintenance Organizations
Reference Laboratories
Blood Donor Centers

Health Management Organizations (HMO)

HMOs are managed care group practice centers providing a variety of services.
Physicians' offices, clinical labs, radiology, physical therapy and outpatient surgery can be found at one location.
Members are charged a prepaid fee for services.
Phlebotomists are employed as part of the clinical laboratory staff.

Reference Laboratories:

Large, independent labs contract with healthcare providers to perform routine and specialized tests.
Phlebotomists collect samples from patients referred to the reference laboratory.
National Reference Laboratories (NRL) in the Philippines include: the National Kidney Transplant Institute, Research Institute for Tropical Medicine, Lung Center of the Philippines, East Avenue Medical Center, and STD-AIDS Cooperative Central Laboratory (SACCL).

Blood Donor Centers:

Phlebotomists collect, label, and prepare blood, plasma, and other components for transfusions.
They interact with the public, conduct interviews, and test samples to screen potential donors.

Patient's Rights (DOH)

Right to Appropriate Medical Care and Humane Treatment: Without any discrimination and within the limits of the resources.
Human dignity, convictions, integrity, individual needs and culture should be respected.
If immediate treatment cannot be given, the person shall be directed to wait or be referred elsewhere.
Right to Informed Consent: Clear, truthful, substantial explanation of proposed procedures in an understandable manner.
The person performing the procedure shall provide their name and credentials to the patient.
Right to Privacy and Confidentiality: Patients can demand that all information and records pertaining to their care be treated as confidential.
Right to Information: Patients have a right to be informed of the evaluation's results regarding the nature and extent of their disease.
Right to Choose Health Care Provider and Facility: Patients can discuss their condition with a consultant specialist at their request and expense.
Patients can seek a second opinion from another health care provider.
Right to Self-Determination: Patients can avail themselves of recommended diagnostic and treatment procedures.
Any person of legal age and sound mind may make an advance written directive for physicians to administer terminal care when he/she suffers terminal illness.
Right to Religious Belief: Patients can refuse medical treatment that contradicts their religious beliefs, unless parents impose treatments on children who have not reached legal age in a life-threatening situation, as determined by the physician.

Other Patient Rights

The right to medical records.
The right to leave.
The Right to Refuse Participation in Medical Research is provided with an institutional review board or ethical review board in accordance with the Declaration of Helsinki.
The right to correspondence and receive visitors.
The right to express grievances.
The right to be informed of their rights and obligations as a patient.

Torts

A tort is a wrongful act that causes harm to another person or their property.
Intentional Torts include Assault, Battery, and Defamation.
Unintentional Torts include Negligence and Malpractice.
Assault is a threat to touch another person without consent and with the intention of causing fear of harm.
Battery is actual harmful touching without consent.
Defamation is spoken or written words that can injure a person's reputation.
Releasing or overhearing confidential information is an example of defamation.
Libel is false defamatory writing that is published.
Slander is a false and malicious spoken word.
Invasion of Privacy is the violation of the patient's right to be left alone.
Unwanted releasing of confidential information or entering a patient's room without permission are examples of invasion of privacy.
Medical Malpractice is misconduct or lack of skill by a health-care professional that results in injury to the patient.
Negligence is a failure to give reasonable care by the health-care provider.
Four factors must be proven to claim negligence: Duty, Breach of Duty, Causation, and Damages.

Phlebotomy Reminder

In phlebotomy, be wary of the following that may cause the patient to file a case of malpractice/negligence: Nerve Injury, Hemorrhage from accidental arterial puncture or inadequate pressure to the vein.
Drawing from inappropriate locations (same side as mastectomy).
Injuries occurring when a patient faints
Death of a patient caused by misidentification of a patient or sample

Clinical Laboratory Sections:

Hematology: Cellular elements (RBCs, WBCs, platelets) are enumerated and classified in all body fluids and bone marrow.
Coagulation: The overall process of hemostasis is evaluated, including platelets, blood vessels, coagulation factors, fibrinolysis, inhibitors, and anticoagulant therapy (heparin and Coumadin).
Clinical Chemistry: This is the most automated area.
Clinical Chemistry performs electrophoresis, therapeutic drug monitoring and performs enzyme immunoassays to measure substances such as proteins, carbohydrates, enzymes, hormones, and toxicology.
Blood Bank (Immunohematology): Blood is collected, stored, and prepared for transfusion here.
Testing procedures in the blood bank involve RBC antigens (Ag) and antibodies (Ab).
Blood from patients and donors is tested for its blood group (ABO) and Rh type.
Compatibility (crossmatch) testing between patient and donor performed.
Abnormal antibodies are also detected and identified.
Serology (Immunology): Tests are performed to evaluate the body's immune response, antibodies (immunoglobulins), and cellular activation.
Microbiology: Responsible for identifying pathogenic microorganisms for hospital infection control; section may be divided into bacteriology, mycology, parasitology, and virology.
Common tests in Microbiology include Culture and Sensitivity, and Gram Staining.
Urinalysis: (UA) may be a separate laboratory section or part of hematology or chemistry.
Urinalysis is a routine screening procedure to detect kidney disorders/infections and metabolic disorders.
Urinalysis consists of a physical, chemical, and microscopic exam of urine.
Histopathology/Histology Section: Histology technicians and technologists process and stain tissue from biopsies, surgery, autopsies, and frozen sections.
A pathologist then examines the tissue.
Cytogenetics: Chromosome studies are performed to detect genetic disorders.

Other Sections

Phlebotomy
Sample Processing

Laboratory Personnel:

Laboratory Director (Pathologist): Specialist in the study of disease (clinical and anatomical pathology).
The Lab Director acts as a consultant to physicians.
Has direct responsibility for all areas of the laboratory. Also responsible for establishing lab policies, interpreting test results, performing bone marrow biopsies/autopsies, and diagnose disease by examining tissue specimens or cell preps.
Laboratory Manager (Administrator) or Chief-Medical Technologist: Responsible for the technical and administrative management. Usually an MLS with a master's degree and 5+ years of experience.
Technical Supervisor or Section Head: MLS with experience and expertise related to a particular section, often with specialty certifications.
Responsibilities of the technical supervisor include: reviewing test results, consulting with the pathologist on abnormal results, scheduling personnel, maintaining instruments, preparing the budget, mainting reagents and supplies, orienting, evaluating and teaching personnel, and providing protocols for new test procedures.
Medical Laboratory Scientist: Has a bachelor's degree in medical technology and 1 year of training in an accredited program.
Medical Laboratory Scientist performs lab procedures that require independent judgment with minimal supervision.
They maintain equipment and records, perform quality assurance, and preventative maintenance.
Medical Laboratory Technician: Performs routine procedures according to established protocols under supervision.
Their duties include collecting/processing biological samples, performing routine tests, recognizing factors affecting test results, reporting abnormal results/equipment malfunctions, demonstrating skills to new employees.
Phlebotomist: Collects blood from patients for lab analysis and has completed a structured phlebotomy training porgram.
They are trained to identify the patient properly and obtain the correct amount of blood by venipuncture or microtechnique.

History of Phlebotomy

Phlebotomy means "to cut a vein" from the Greek words "Phelb" (vein) and "tomia" (to cut).
The earliest forms of phlebotomy can be traced all the way back to the ancient Egyptian, ancient Greek and Roman cultures.
Phlebotomy used to be called "Bloodletting".
Draining blood was considered one way to effectively cure the body of illness.
Illness were described as "bad spirits" and was performed using a lancet tool.
In 1163, Pope Alexander III prohibited clergyman from performing bloodlettings thus barbers took over as they were naturally skilled with sharp objects as Barber-Surgeons.

Traditional Duties of a Phlebotomist:

Correct identification and preparation of the patient before sample collection.
Collection of the appropriate amount of blood by venipuncture or dermal puncture for the specified tests.
Selection of the appropriate sample containers for the specified tests.
Correct labeling of samples with the required information.
Appropriate transportation of samples back to the laboratory in a timely manner.
Effective interaction with patients and hospital personnel.
Processing of samples for delivery to the appropriate laboratory departments.
Performance of computer operations and record-keeping pertaining to phlebotomy.
Observation of all safety regulations, quality control checks, and preventive maintenance procedures.
Attendance at continuing education programs.

Additional Duties of Phlebotomists:

Training other health-care personnel to perform phlebotomy.
Monitoring the quality of samples collected on the units.
Evaluation of protocols associated with sample collection.
Performing and monitoring point-of-care testing (POCT).
Performing electrocardiograms.
Performing measurement of patient's vital signs.
Collection of arterial blood samples.
Collection of samples from central venous access devices (CVADs).

Characteristics of Phlebotomists:

Dependable, cooperative, committed.
Compassionate, courteous, respectful.
Integrity, honesty, competence.
Organized, responsible, flexible.
Appearance (Clothing, Hygiene).
Communication: verbal & non-verbal, body language.
Respecting Cultural Diversity.
To accommodate patients with hearing impairments, speak loudly, clearly and look at the patient. Communicate in writing if necessary.
Behave calmly and slowly with affected patients.
Avoid medical jargon and use age appropriate language.
For non-English speakers, locate a hospital-based interpreter and use hand signals.