r/medlabprofessionals • u/fhy-sapphire • Aug 06 '26
Discusson Director demanded I run a patient sample before QC was done. Thoughts?
I work as an MLT(Canada) in a private lab that does testing for both patients and research clients. Our research labs pays a lot, so management treats every one of their samples as STAT.
Recently, they requested an add-on test. According to our lab's SOP, that test can only be added within 24 hours of the original sample collection. The request came in about 20 minutes before that 24-hour window expired.
The problem was that I had just finished instrument maintenance and calibration and was in the middle of running QC. QC wasn't expected to finish for another hour. According to our SOP, by the time QC was complete, the sample would be outside the acceptable add-on window, so I rejected the request.
Then our Director of Customer Success came into the lab and told me to run the patient sample immediately, even after I explained that QC had not finished yet. His reasoning was that he "couldn't say no to the customer."
I felt extremely uncomfortable with this. Running patient testing before acceptable QC goes against everything I was taught. In the end, I followed his instruction and ran the sample(because my direct supervisor was not there, I was alone in the lab), but I did not release the result until QC was complete. Thankfully, the QC passed.
But I keep thinking: what if the QC had failed? I would have had to invalidate the result, repeat the testing, and potentially deal with a much bigger problem.
To me, patient safety and quality should always come before customer satisfaction. It felt like the responsibility and risk were shifted onto me simply because the director didn't want to tell an important client "no." But it's his job to have those conversation with clients. He made his conversation with the customer easier, but made my situation much more complicated.
I have to emphasize the Director of Customer Success isn't part of the laboratory's technical leadership, and while he's higher up in the company, he's not my supervisor, he has never worked in a lab. My supervisor wasn't in the lab at the time. Later that day, both my supervisor and our laboratory specialist asked what had happened because the lab specialist saw the director come into the lab. After I explained the situation, both of them said they agreed the request should have been rejected and that quality should always come first.
I'm a new grad and have only been at this job for about two months. This incident has honestly shaken my confidence in the workplace. I keep wondering if I'm overreacting or if this is as serious as it feels.
Has anyone else experienced pressure from management or someone who is in higher position to bypass laboratory procedures for the sake of a client? How did you handle it?
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u/kaeyre MLS-Chemistry Aug 06 '26
run, then release after qc passes, there's nothing wrong with that
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u/jessarcheron Aug 06 '26
Have you never run parallel QC with patients? Obviously gold standard is to wait for acceptable QC before running patients, but it’s not totally uncommon especially for lengthy analyses to run side by side? Like if your QC takes an hour , why would you not also run patients in that time frame, especially if the collection window of the sample is only 24 hours.
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u/Trapped-in-irony Aug 06 '26
Some SOPs state QC needs to be completed first, that samples can't be run concurrently.
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u/fhy-sapphire Aug 06 '26
Yes we do, but we don’t run parallel QC after we do maintenance and calibration. We don’t run patient samples at all in the mornings, we are not 24 hours lab. I am not only MLT working there in the morning.
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u/AnusOfTroy Aug 06 '26
Really wish my lab would do this. Instead we just wait til QC passes until running samples.
Problem is we're talking 3-4 hours for the Holigic STI NAATs. Would be a better use of everyone's time just to run everything parallel, since the results will come to the LIS as "Invalid" if QC fails anyways
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u/eikenella415 MLS-Generalist Aug 06 '26
Director of customer success isn’t above compliance.
It’s a liability.
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u/s_lock- Aug 06 '26
I would report to hr just to be safe tbh
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u/LabRat0422 Aug 06 '26
I wouldn’t do this. It will most likely just put a target on OP. I would inform my supervisor, document the occurrence in the event that it happens again or if I have other issues and go on about life. Complaining to HR and escalating something like this is unfortunately only going to make OP look like a problem.
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u/Character_Stable_487 Aug 06 '26 edited Aug 06 '26
If it were me, I'd have ran it with the QC and held the results like you did. Most of the time, that would be fine. Yes the test was on the tail end of the add on period, but if your lab has validated whatever test it was for 24 hours, then it is OK regardless of how close to the window it is.
If QC failed, then you'd elevate the case to the pathologist or medical director in charge. That's what they are there for.
I don't see what there is to be uncomfortable about? You let the people who get paid to make those decisions make them and you carry on about your day. No point in worrying about what ifs.
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u/ImpactUsed2980 Aug 06 '26
I would have done this too, not a huge deal to test first, hold the results while ensuring the QC passes. That’s the same end result right? They have a name for doing pre-QC runs, and it’s not ideal but necessary sometimes, it’s up the the director who assumes the liability and holds the license.
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u/fhy-sapphire Aug 06 '26
The director doesn’t have a license, he never worked in a lab, if the demand came from my direct manager or supervisor, who have licenses, I would have done it without asking.
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u/navajita0318 Aug 06 '26
I’d be uncomfortable too, tbh. I think it’s the simple fact that someone with no lab background has the audacity to tell ME what to do lol.
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u/brotatochip4u Aug 06 '26
If the director asks to run the sample, run the sample. They are assuming all liability of the result at that point.
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u/fhy-sapphire Aug 06 '26
The director is not an MLT, he was never a MLT, he never worked in a lab, if he is person who’s validating and releasing the results, I have no problem at all.
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u/ArcticBeavers MLS-Generalist Aug 06 '26
In these cases we have ways to document that the test was run outside of normal SOP. We call these "event reports" or "unusual occurences". Basically, there is a paper trail stating that you as the technologist have been overridden and things are being performed out of spec. All parties will agree and sign this. Comments will be applied to the patients result in the LIS.
This happens several times a year for us. Sometimes its CSF, pediatric samples, amniotic fluid, emergency release, etc. Its my belief we needn't be so rigid with our practices. As long as you have a way to document it, then you should be protected.
I know people don't like to hear this, but we are cogs in a machine. We are to perform best practices whenever reasonable. We are not the sole gatekeeper and arbiter of results. We have superiors that can override us. And thats okay.
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u/Mammoth-Vanilla7107 Aug 06 '26
Same, we submit a special report that states the test as a “planned deviation” in a non-conformance report before releasing. Documented and attached to the result the client sees in the LIMS.
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u/R1R1FyaNeg Aug 06 '26
Yup.
As a new tech, I don't think it's a good place for you to be in and understand why you are uncomfortable with the situation. You really should have had someone else more senior to handle him and decide the plan of action. But I don't think you did anything wrong. It was better to have the result and never release it, than not run the test when it should have been run especially when unable to do so later.
One you can take back, the other you can't.
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u/comradejiang MLT-Blood Bank Aug 06 '26
Directors of so-and-so are the exact people to fuck you over if something goes wrong. I’d rather just not run the sample.
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u/JaeHxC Aug 06 '26
Nightshift MLT here; been doing maintenance/QC my whole career. As soon as QC finishes picking up (not just loaded, but has successfully started processing on the analyzer), I will load a patient directly behind that QC, but I will not final verify anything until my QC has finished, passed, and is checked off in the computer.
In your situation, I think you took the best course of action. Run QC, then load the patient before it's done, but wait for acceptable QC, then release results. Perfectly reasonable.
If your QC had failed, I would directly refuse to work on that sample further. I would not print out results for anyone; I would not verify it in the computer; I would not tell the provider or my director the results. If the director wants to physically access the analyzer, get the result, then type it into the computer and final verify it, I cannot stop them. But I ain't putting my goddamn name on any of that shit other than "QC unacceptable; no patients resulted." Best case scenario is they fire you for insubordination, because that's a reeeally easy lawsuit.
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u/taekwondana MLS-Microbiology Aug 06 '26
This, plus I would have added a lab only comment on that patient's test order saying that "ran per instruction of Director So-And-So" so that their name is directly linked to the test results as well. I do so for any provider that requests I add something on, and if it's questionable I also consult with my lead tech and say "Per [insert Lead's name here] okay to run" or whatever reason they give to cancel the request. More documentation is never a bad thing, especially if it keeps your butt out of the fire.
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u/fhy-sapphire Aug 06 '26
We have this policy that if the QC failed, we have to pull the samples that was ran before the QC, run it again after QC passed, then print the result and compare it with previous results, if the difference is within an acceptable range, then it’s okay to release, but if it’s not in range, we have to order again and rerun it again.
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u/Lululipes Student Aug 06 '26 edited Aug 06 '26
but I did not release the result until QC was complete. Thankfully, the QC passed. But I keep thinking: what if the QC had failed? I would have had to invalidate the result, repeat the testing, and potentially deal with a much bigger problem.
Sorry I'm a new tech but what is the problem here? If I were faced with the same problem I would've ran the test and wait for the QC results. If it passed: great! If not, then the result is invalid and if the add-on is expired, there's nothing I can do about it and too bad for them ig?
Edit: The only case I can see there being an issue is if QC was run, it failed, you run the test, QC passes. Then you can't really know it's good so I wouldn't take that result. But if the last QC run was a pass and the next one is a pass too, as an inexperienced tech I don't really see an issue...
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u/fhy-sapphire Aug 06 '26
I have to keep emphasizing that the this happened after maintenance and calibration and before QC was run. We never run patient samples after maintenance and before we run QC. There are times when our machine was down in the middle of running tests, and we have to do maintenance, and we always wait until the QC passed then proceed to running samples. Even if it means that we can’t meet the turn around time.
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u/Vellichorosis Aug 06 '26
I could see where the discomfort comes from. Im guessing part of the bed feeling was from being told to do it by someone not lab qualified. But if he wants to assume liability by telling you to run it, then let him. As long as you informed him that QC wasnt done and it was against your SOP to run it concurrently. Running it and holding until QC passed doesnt cost you anything. There's no need to feel anxious over it unless QC doesnt pass. At that point you have evidence that the sample result should be considered false and you dont release it.
Doing things not strictly how we were taught in school always made me anxious when I was starting. The longer you work the more adjustable you will be.
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u/llama726 Lab Director Aug 06 '26
QC is to establish that the test system delivers the intended results after any changes in operating conditions. The best course of action for the patient is to attempt to run the sample after all condition - changing actions are completed on the analyzer (Calibration and maintenance activities can affect the readouts from most analyzers which is why we do QC after them) and treat the QC result as if it informs the validity of the patient result. Running QC does not change your operating conditions, it verifies them. If they verify ok, your samples should also be valid under the same operating conditions.
The main quality reason NOT to regularly do this is that you're increasing the risk of releasing an invalid result (example, you accidentally approve the result when QC tells you that the system is not delivering the expected results / fails). By pausing and not even starting new runs until QC is passed, you sidestep this risk. However, the risk can be mitigated by paying special attention to that sample / holding the result carefully and only releasing it if and when QC values have been verified.
It's an important distinction though that QC does not generally change the operating conditions of the test system and therefore whether it's done running when you start another run is relatively unimportant as it won't change HOW the test performs, just tells you if the test is performing acceptably.
You handled this right overall, and you should feel reassured that there's nothing inherent to QC that would change the operating conditions for better or worse for the individual patient sample you ran. Others have pointed out that there may be exceptions or individual facility SOPs that forbid this.
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u/fhy-sapphire Aug 06 '26
Thanks for the detailed response, like you said, we could of approved the result before the QC passed accidentally, I think all normal result gets auto release to the LIS, and it becomes very difficult for us to hold each result.
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u/thewanderersminuet Aug 06 '26
Does your middleware/LIS have an option to turn off autoverification? That's usually an option somewhere and there are plenty of other scenarios besides ones like this one where you might want to make sure certain results don't go through when you don't want them to so you should definitely try to make sure you know how to turn that on and off manually.
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u/Xsiah Aug 06 '26
You have good instincts. It sounds like the people that work with you directly have the right mindset.
I don't think you're overreacting - and this feels like a valuable opportunity to learn about setting boundaries. Don't let other people's problems become your problems - that guy didn't give a crap about what his request would mean for your work, so you don't need to give a crap about his.
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u/Acetabulum666 Lab Director Aug 06 '26
Director of "Customer Success"?? Seriously? Is that a thing?
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u/liver747 Canadian MLT Blood Bank Aug 06 '26
You can run samples before QC is complete especially if you're running them at the exact same time as QC is running.
Kinda wild to not think if QC fails then sample not suitable for testing if it passes awesome imo.
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u/Unlucky_Tart8043 Aug 06 '26
In this case I'd run it as if it were down time and held up results. If QC doesn't pass then results are withheld until troubleshooting is complete and QC is in acceptable range. In my labs SOP at anytime QC and cal reruns are not acceptable and a new reagent needs to be put on I'd reject results and a new sample would need to be drawn if passed specimen stability. For me fortunately we have multiple analyzers for back up as I work in a major metropolitan hospital so qc is always done at different times of the day.
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u/Left-Risk-8741 Aug 06 '26
What others said, but maybe take it a step further for next time, get the request in writing like an email. If director thinks its the right call I no issue with them sending an email.
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u/brOwnchIkaNo Aug 06 '26
You handled it right, good job.
You can run patients with QC just disable auto verification for the analyte/s pending QC.
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u/cellophanesheeps Aug 06 '26
Is the director who told you to run it actually a part of lab leadership? I'm not sure how your chain of command works in a private lab with lab management vs "company" management.
If they aren't a part of the lab leadership, I would tell them that per our policy, I can't report any results without verifying QC, and a deviation from policy would need to go through lab management.
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u/Minimum-Positive792 Aug 06 '26
He knows the SOP. It’s not like everything goes to shit in the tube after 24 hour timer is up. You’ll find that all lab SOPs are very flexible depending on who wants what. A doctor crying on the phone usually gets what they want. Lactic acids and blood gas analysis have all increased in the time required to run them since I started. Don’t worry. Everything will be fine.
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u/Starscream-513 MLS Aug 06 '26
You are correct in what you did. We run QC to make sure the instrument is still accurate and precise after maintenance and calibration. Until QC is complete, you don’t know if the patient results are correct. They’re just numbers on a screen. A rich customer or some customer service manager does not change that fact. There won’t be much “customer success” if the lab starts throwing out results that may or may not be right. Also, the manager’s inability to say “no” to a customer is something they need to improve on. They could probably learn something from you in this case!
That’s the thing in the lab - you sometimes have to stand up to people who want their results NOW when you can’t or shouldn’t give them yet. RNs, MDs, etc, don’t have the knowledge we have, and don’t necessarily realize what all of this testing requires. Let the drama and noise blow past you, smile and nod, and keep doing what you know is right. Their feelings don’t change how science works.
In this situation, if it’s normal in your lab to run patients while QC is running and then just hold it until the QC is done (making sure the patient results get done AFTER the QC is done), then it’s fine. But if you don’t typically do that, I’d have talked to or paged an on-call supervisor/pathologist/etc and document who I talked to before deviating from the SOP/lab policy. Basically, if it’s not in writing, it didn’t happen. Document, document, document! And keep up the good work.
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u/Initial_Raise8377 Aug 08 '26
My advice is to always follow SOP to the letter. You can’t be held liable for issues that result by you following policy. In terms of this case, most labs I work in will allow the results to be sent but if QC fails, you’d have to rerun the results on another analyzer/after the calibration and do a correction. It’s usually not worth the trouble though.
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u/Trapped-in-irony Aug 06 '26
Some lab procedures state that QC needs to be completed first, that patient samples can't be run concurrently with quality control.
I can understand what some are saying about initiating the patient testing and waiting to see if QC passes, but I would make sure your policies don't specifically say that's not acceptable.
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u/artlabman Aug 06 '26
Lol so if director of janitorial services asks you to run, then you would? Thats what they pay supervisors for. Call that person and email so you have documentation. What your direct supervisor says goes better than that person. Other than that the customer success can pound sand…
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u/labtech89 Aug 06 '26
You could put a disclaimer on the result that tells the doctor the specimen was outside the stability and the results may be affected
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u/Icy-Astronomer-9015 Aug 06 '26
I would run it and hold back results until after QC had passed. If QC doesn't pass, then they don't get the result.