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Lab shoots for better phlebotomy service, satisfied patients

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Kevin B. O’Reilly

March 2016—Try running a race and tying your shoes at the same time. That is the kind of challenge laboratories face when they endeavor to refine their processes while providing all the usual services clinicians and patients expect. When laboratory leaders at Brigham and Women’s Hospital in Boston surveyed the landscape of their phlebotomy operations, they spotted many opportunities for improvement through Lean Kaizen events as well as technology that reduces the risk of human error.

On the outpatient side, patients showing up for blood draws encountered long waits, felt confused about when a phlebotomist would see them, and were even in the dark on the main outpatient phlebotomy area’s operating hours.

On the inpatient side, blood draw times varied widely from phlebotomist to phlebotomist, it often took more than half an hour after phlebotomists started work for them to draw their first patient, and the rate of preanalytical errors such as wrongly labeled specimens was too high.

Across inpatient and outpatient operations, the Brigham team—led by Milenko Tanasijevic, MD, MBA, and Stacy Melanson, MD, PhD—measured the phlebotomy capacity required at different times of the day and week and found that suboptimal staffing contributed to delays in collection and, consequently, longer patient waits and turnaround times.

Theirs is a multiyear project that has achieved dramatic improvements, among them a 76 percent reduction in average patient wait times and a 41 percent cut in specimen labeling errors.

The most recent aim was to further reduce preanalytical errors such as mislabeled or unlabeled specimens. Earlier implementation of a barcode-based, handheld positive patient identification system in inpatient phlebotomy helped to achieve the 41 percent cut in labeling errors, from 5.45 to 3.2 per 10,000 specimens (Morrison AP, et al. Am J Clin Pathol. 2010;133:870–877).

There were still opportunities to decrease preanalytical errors, however. At the time, Brigham employed homegrown hospital and laboratory information systems that lacked electronic order communication, so phlebotomists and nurses drawing blood worked with paper requisitions. While the patient’s wristband barcode had to match the patient identified in the handheld system, that patient was selected manually based on the paper requisition. That meant the phlebotomist doing the draw could accidentally mismatch the requisition and the labeled tubes or draw the wrong tube type.

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