ARC Scenario for Medical Laboratory Technology
A supervisor who was reviewing HIV 1/2 ELISA test results noticed that a negative test result had been
reported on a patient who she remembered tested positive a few weeks ago. She reported the
discrepancy to the lab’s medical director. He had the specimen retested twice and both results were
positive. The control values from the run that gave the false-negative result were reviewed and found to
be in range. The medical director had a corrected report sent to the ordering physician and instructed the
technologists to run all tests in duplicate and to only release test results if both results were in
agreement.
A few days later a technologist noticed that one of the patient wells in the HIV microtiter tray had less
fluid than the other wells. Further investigation revealed that the instrument’s automated pipettor was
not always dispensing the full volume of the sample. The laboratory estimated that the error occurred in
approximately 1 of 400 tests. The analyzer had been in use for eight months. During that time
approximately 30,000 specimens had been tested and 1% were reported positive for HIV.
The risk management team met to decide on a course of action. All agreed that a letter should be sent to
the ordering physicians alerting them to the possibility of false-negative test results. The team debated
about what additional steps to take, if any. The technical director thought that the laboratory should
also send letters to all patients who received a negative test result since the instrument was put into use,
that the letter should recommend that the patients have a repeat test, and that the laboratory should
provide the testing free of charge. The administrative director thought that the only patients who should
be notified were those who tested negative between the day of the false-negative result and the time
that duplicate testing was started. She thought that the letter should offer free repeat testing, but not
actually recommend it. The medical director thought that notifying the ordering physicians was sufficient
and that the laboratory should provide them with the names of the patients who might have been
affected by the error, as well as patient notification letters that the physicians could send as they
deemed appropriate. He did not think the laboratory should recommend or offer repeat testing but that
they should be prepared to offer it free of charge if any of the physicians or patients requested it. The
team also talked about whether they should reverse the original charges and whether they should send
out a press release. They also discussed replacing the analyzer with one that could detect dispensing
errors.
Assignment:
1. Read the SPC definition of critical thinking.
2. Read over the ARC Scoring Template to see the elements of critical thinking and how they are
evaluated.
3. Apply the elements of critical thinking to the scenario by doing the following (in writing):
1. Define the problem in your own words. (Communication)
2. Compare & contrast the available solutions within the scenario. (Analysis)
3. Select one of the available solutions and defend it as your final solution. (Problem Solving)
4. Identify the weaknesses of your final solution. (Evaluation)
5. Suggest ways to improve/strengthen your final solution. You may use information not
contained within the scenario. (Synthesis)
6. Reflect on your own thought process after completing the assignment. (Reflection)

What did you learn from this process?

What would you do differently next time to improve?
4. Evaluate the critical thinking in your written work using the ARC Scoring Template.