3. Application of Critical Thinking Skills to Constructively Investigate, Evaluate and Problem Solve

Application of Critical Thinking Skills

• The application of critical thinking skills is a professional competency expected of Medical Laboratory Technologists (MLT) and Medical Laboratory Assistants (MLA).

• Several parameters must be considered when applying critical thinking for investigation and problem-solving:

1. Identification of Error

• Recognize unexpected results:

  • Recognition of results that do not align with patient history or expected norms.

• Recognize implausible results:

  • Results that are statistically or clinically improbable based on prior data.

• Understand instrument flags:

  • Identify warnings or flags presented by lab instruments indicating potential errors.

• Identify inconsistencies in patient data:

  • Example: Hemoglobin (Hgb) is very low while hematocrit (Hct) is normal.

  • Case Scenario: A patient last typed as O Positive now types as B Negative upon reassessment.

2. Evaluate/Analyze Methodically

• Correlate relevant data:

  • Revise patient history and assess previous lab results for discrepancies.

  • Investigate if the issue is sample-related, equipment-related, method-related, or a matter of specimen integrity (e.g., hemolysis, lipemia).

  • Determine where the error occurred: preanalytical, analytical, or postanalytical.

• Evaluate possible causes for the problem:

  • Specimen quality:

    • Pre-analytical error examples: wrong tube collected, tube only half filled, did not follow the order of draw, etc.

  • Reagent issues:

    • Reagents being expired, contaminated, or insufficient in volume.

  • Equipment malfunction:

    • Incorrect aspiration of reagents or specimens or burnt lights producing inaccurate readings.

  • Transcription errors:

    • Incorrect labeling and documentation before analysis.

3. Constructive Investigation

• Repeat test when necessary:

  • Determine if dilution is required and assess the instrument’s linearity and calibration data.

• Review Quality Control (QC) and calibration data.

• Consult Standard Operating Procedures (SOP) and collaborate with colleagues.

4. Effective Problem-Solving

• Implementing critical thinking:

  • Develop and apply solutions with a focus on patient safety and test reliability.

  • Choose the appropriate corrective action:

    • Troubleshooting instruments, recollecting patient samples, notifying supervisors, etc.

• Formulating solutions:

  • Consider the options:

    • Repeating the test, diluting the sample, recollecting from the patient, or recalibrating instruments.

• Example Procedure:

  • If hemolysis noted in a potassium test resulting in a grossly elevated K+, recollect and test without hemolysis, confirming it as the issue.

5. Reflection and Learning

• Importance of reflection:

  • Reflection and ongoing learning are pivotal for personal growth and high-quality patient care.

  • Analyzing decisions and outcomes continuously enhances critical thinking skills.

  • Adapting to new testing methods and technologies in the lab improves patient care effectiveness and safety.

Example in Lab Practice

• Scenario: A patient needs a transfusion of two units of blood that turn out to be incompatible.

  • Actions to take:

  • Review patient transfusion history and all related documentation.

  • Evaluate antibody screen results and perform additional testing like an antibody identification panel.

  • Communicate findings with the ordering physician.

Knowledge of a Dynamic Environment

• Health care and clinical laboratories are perpetually changing due to:

  • Introduction of new technologies and automation.

  • Changes in workload (e.g., STAT orders, mass casualty response).

  • Updates to SOP policies/regulations and procedures.

  • Increased collaboration among interdisciplinary teams (nurses, physicians, allied health).

• Demonstration of knowledge is seen in MLTs/MLAs as they adjust to changing patient needs and priorities.

Adaptation and Response to Change

• MLTs/MLAs:

  • Do not resist change and are prepared for tasks as they arise.

  • Are flexible, multitask effectively, and adjust workflows in response to urgent situations (e.g., STAT samples).

  • Demonstrate fast learning capabilities (e.g., learning new methodologies due to COVID-19 testing).

  • Solve problems effectively under pressure (e.g., addressing equipment malfunctions).

  • Maintain professionalism and composure in stressful environments.

Impact of Changes on Other Areas

• Changes initiated in one area can significantly affect other healthcare areas:

  • The laboratory plays a crucial role in clinical decision-making and communication across departments.

  • Changes may impact patient care and outcomes, affecting various departments (nursing, emergency, pharmacy).

  • Resources, such as staffing and turnaround time, can also be influenced by changes.

Examples of Changes Affecting Other Areas

• Introduction of new procedures/instrumentation (e.g., rapid PCR assays) leading to faster diagnostics and decisions.

  • Impacts on healthcare providers’ capabilities to expedite treatment decisions.

  • Pharmacy workload increases due to the need for new antibiotic treatments.

  • Infection control measures may need to be enforced more quickly.

  • Equipment malfunctions might lead to increased turnaround times.

  • Policy changes regarding specimen collection and new swab requirements necessitate training for nursing staff.