Organizational Structure: I N Patient La Boratories

4 PA R T 1 Laboratory Principles
certification agency created by laboratory professionals in other settings may be sent to the hospital's clinical labora
the 1 970s to credential laboratory professionals. The ASCP tory for analysis. Clinical laboratory workers are hospital
Board of Registry and the NCA merged in 2009 to create employees, and they are an important part of the health
the ASCP Board of Certification. care team.
Another organization that certifies laboratory profession
als and other medical professionals is the American Medical Organizational Structure
Technologists (AMT) . The AMT was founded in 1 939 and Hospitals are an invention of the 20th century. Hospitals
is a nationally and internationally recognized certification were known as almshouses before the 20th century. Alms
and membership society for medical technologists, medi houses were places where poor people or people without fam
cal laboratory technicians, phlebotomy technicians, medical ily members to care for them would go to receive care. These
laboratory assistants, clinical laboratory consultants, medi facilities provided food, shelter, and rest. Before the 20th cen
cal assistants, medical administrative specialists, dental assis tury, the best medical care was received at home; even opera
tants, and allied health instructors. tions were performed in the home. As medical procedures
In 1 933, clinical laboratory technicians formed a profes and equipment became more advanced, the patient went to
sional society, the American Society for Clinical Laboratory see the doctor instead of the doctor coming to see the patient.
Technicians, to provide autonomy and a voice for the grow
ing profession of clinical laboratory science. Years later, the Hospital
organization changed its name to the American Society for There are approximately 6500 hospitals in the United States.
Medical Technology and then to the American Society for They are classified as public, private, specialty, community,
Clinical Laboratory Science (ASCLS) . federal, military, or other types.
In the 1 940s and 1 950s, clinical laboratory testing analyzed Hospitals are organized in three distinct parts: govern
specimens such as blood and urine. Laboratories also housed ing board, medical staff, and management. The governing
and used animals in the test procedures. An example is the board is the body responsible for the financial health of the
pregnancy test where urine from a woman suspected of being organization and for setting institutional policies and goals.
pregnant was injected into a rabbit. After a specific time period, The governing board appoints the medical staff as the party
the rabbit's ovaries were examined for ovulation. If the ovaries responsible for quality patient care.
were swollen and ovulating, the woman was pregnant. In the The medical staff members of the hospital are not usu
1 960s, laboratories used frogs to detect pregnancy in women. ally considered to be employees; however, more hospitals
By the 1 970s, more reliable and valid test procedures were and hospital systems are employing health care providers.
introduced into the clinical laboratory for pregnancy testing. In the traditional structure, the medical staff is granted
More sensitive test procedures were introduced in the 1 970s the right to admit patients and perform procedures in the
(e.g., radioimmunoassay) and 1 980s (e.g., enzyme immunoas hospital.
says) . Bioluminescence assays attained widespread use in the The management portion of the hospital consists of
1 990s. As more sensitive test procedures were introduced in the the hospital administrator as the chief executive officer
clinical laboratory, more test analyses were added. who is responsible for managing all hospital departments.
Figure 1 - 1 shows the relationships among the three parts
Types of Clinical Laboratories of the hospital and shows where the laboratory fits into the
organizational structure.
Clinical laboratories are a dynamic area in health care. Lab
oratories produce 80% of the objective data that health care Clinical Laboratory
providers use to diagnose and rule out diseases, to provide Clinical laboratories are composed of many different depart
blood for transfusion, and to determine the susceptibility of ments. The laboratory services department is usually sepa
pathogenic bacteria to antibiotics. Clinical laboratories are rated into anatomic and clinical pathology. The anatomic
found in hospitals, outpatient clinics, and physicians' offices pathology department examines all tissues, fluids, organs,
and as stand-alone reference laboratories. Laboratories are and limbs removed from the body. This discipline com
constantly integrating new technology and instruments to prises surgical pathology, histology, and cytology. Personnel
better meet the needs of health care providers and patients. in the anatomic pathology department include pathologists,
The following sections describe the types of clinical labora pathologists' assistants, histology technicians, and cytology
tories, structures of organizations and laboratories, labora technicians. In the anatomic pathology department, tis
tory personnel, and laboratory departments. sues are described by pathologists, cut into sections, fixed
with chemicals, sliced very thin, placed on glass slides, and
I n patient la boratories stained with special chemicals. After the slides are stained
and cover slipped, the pathologist examines the tissue for
Clinical laboratories began as part of a hospital in the early abnormalities.
20th century and remain a critical part of hospitals today. Clinical pathology is the largest portion of the clinical
Although the clinical laboratory may be located in the hos laboratory. This section is composed of hematology, clinical
pital, work from outpatient clinics, nursing homes, and chemistry, microbiology, immunohematology, toxicology,

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4 PA R T 1 Laboratory Principles

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