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