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Molecular Biology

Intra/Interdepartmental Relations

In the realm of Molecular Biology, technical proficiency is insufficient without effective communication. The molecular laboratory does not exist in a vacuum; it acts as a central hub for precision medicine, infectious disease control, and antimicrobial stewardship. Because molecular testing often involves high-cost assays, complex genetic nomenclature, and longer turnaround times than routine chemistry, the Laboratory Scientist must actively manage relationships with clinical staff (nurses, physicians), institutional partners (Infection Control, Pharmacy), and other laboratory sections (Microbiology, Histology) to ensure patient safety and operational efficiency

Communications with Clinical Staff (Physicians & Nurses)

The primary source of friction between the laboratory and the clinical floor is a mismatch in expectations regarding Turnaround Time (TAT) and test utility. Molecular assays often run in batches or require multi-hour processing times, unlike the rapid, random-access nature of the Core Lab. Effective communication requires moving from a transactional model to a consultative model

  • Pre-Analytical Consultation (Ordering Guidance)
    • Test Menu Clarity: Molecular test names can be confusing to providers (e.g., distinguishing between C. difficile Toxin PCR vs. Antigen EIA). The laboratory must ensure the Laboratory Information System (LIS) order catalog is clear. Scientists often field calls to guide physicians toward the correct order to avoid expensive, unnecessary testing
    • Sample Requirements: Because molecular assays are highly sensitive to inhibition (e.g., Heparin) and degradation (RNA stability), the lab must aggressively communicate rejection criteria. When a specimen is rejected, the scientist must explain why (e.g., “The heparin will inhibit the polymerase, yielding a false negative”) rather than simply stating “Wrong Tube,” to educate the nurse and prevent recurrence
  • Managing TAT Expectations
    • The “Stat” Dilemma: Clinicians often mark molecular tests as “Stat” without understanding the workflow constraints (e.g., a 4-hour PCR run that cannot be interrupted). The scientist must communicate realistic completion times (e.g., “The next run starts at 10:00 AM and releases at 2:00 PM”) to manage care planning
    • Pending Lists: Proactive communication involves monitoring “Pending” lists. If an instrument fails or a run is delayed, the laboratory should notify the Emergency Department or ICU before they call to complain
  • Post-Analytical Reporting (Interpretation)
    • Critical Values: Certain molecular results are immediately life-threatening or require isolation (e.g., N. meningitidis in CSF, or a Select Agent). These require immediate verbal notification and a documented “Read-Back” from the provider
    • Interpretive Comments: A report stating “MecA Detected” or “Factor V Leiden Heterozygous” may not be immediately understood by a generalist practitioner. The scientist ensures that LIS comments clearly translate the molecular finding into clinical relevance (e.g., “MecA Detected: Organism is Methicillin-Resistant S. aureus (MRSA). Resistant to Oxacillin/Nafcillin”)

Collaboration with Institutional Partners

The molecular laboratory is a key data generator for hospital-wide initiatives, specifically regarding Infection Prevention (IP) and Pharmacy (Antimicrobial Stewardship). These interdepartmental relationships are vital for hospital accreditation and patient safety

  • Infection Prevention (IP)
    • Surveillance: The molecular lab provides the data for tracking Hospital-Acquired Infections (HAIs). Rapid reporting of MRSA, VRE, and C. difficile allows IP to place patients in contact isolation, preventing outbreaks
    • Outbreak Investigation: During a suspected outbreak, the molecular lab may be asked to retain samples for genotyping or to perform rapid screening of asymptomatic patients. Communication channels must remain open 24/7 to coordinate these responses
  • Pharmacy & Antimicrobial Stewardship
    • De-escalation of Therapy: Rapid molecular identification (e.g., Blood Culture Identification Panels) allows pharmacists to switch patients from broad-spectrum antibiotics (Vancomycin) to targeted therapy (Cefazolin) hours or days faster than traditional culture
    • Antibiogram Data: Molecular detection of resistance markers (e.g., vanA/B, KPC, CTX-M) provides early warning of Multi-Drug Resistant Organisms (MDROs), allowing Pharmacy to intervene before the phenotypic sensitivity is available

Intra-Laboratory Relations (Internal Handoffs)

The Molecular Department often shares specimens with Microbiology, Histology, and Cytology. These “Shared Specimen” workflows are high-risk points for cross-contamination or sample loss. Rigid protocols and mutual respect between departments are required to preserve specimen integrity

  • Microbiology Handoffs
    • “Molecular First”: When a single swab is submitted for both Culture and PCR, the Molecular department should ideally aliquot the sample first. Opening the tube in the open-air Microbiology setup area introduces environmental contaminants that can cause False Positives in the sensitive molecular assay
    • Reflex Testing: Protocols often dictate that negative molecular results trigger a culture set-up (or vice versa). Handoffs must be tracked in the LIS to ensure the sample doesn’t get “lost” between the two benches
  • Anatomic Pathology (Histology/Cytology)
    • Fixation Issues: Molecular oncology relies on tissue blocks. The molecular scientist must communicate with Histology regarding fixation times. Over-fixation in Formalin heavily cross-links DNA, causing PCR failure. Decalcifying agents (for bone marrow/bone) utilizing strong acids destroy nucleic acids; EDTA-based decalcification must be requested
    • The “Sandwich” Technique: To prevent cross-contamination at the microtome, Histology cuts a slide for staining, then cuts the molecular curls/scrolls, then cuts a final slide. The molecular lab relies on the Pathologist’s review of the flanking slides to verify the tumor percentage in the sample provided

Specimen Processing & Reception (Accessioning)

The relationship between the bench scientist and the specimen reception staff (Accessioning) is the first line of defense against pre-analytical error. The molecular scientist acts as the subject matter expert for the front-end staff

  • Education and Feedback: Specimen processors handle thousands of tubes. The molecular scientist must provide visual aids (e.g., charts showing “Purple Top = Yes, Green Top = No”) and immediate, non-punitive feedback when errors occur
  • Storage Triage: Accessioners must know that RNA samples (Viral Loads) have strict time-to-freeze requirements. The molecular lab must clearly communicate which samples can sit at room temperature and which must be centrifuged and frozen immediately to prevent rejection

Conflict Resolution & Professionalism

High-stress environments inevitably lead to interdepartmental conflict. Whether it is a nurse angry about a rejected sample or a doctor demanding an impossible turnaround time, the laboratory scientist must maintain professionalism

  • Documentation: All contentious interactions regarding specimen rejection or delays should be documented in the LIS internal comments. This protects the laboratory by creating a timeline of events
  • The “No” Script: When refusing a request that violates policy (e.g., testing an unlabeled tube), the scientist must frame the refusal in terms of patient safety (“I cannot test this because I cannot guarantee the results belong to this patient”) rather than bureaucratic obstinacy