Achieving Optimal Laboratory Blood Testing Turn-around Time for Effective Patient Care Decisions: A Lenox Hill Hospital Experience

1. 0%
20%
40%
60%
80%
100%
Apr May Jun Jul Aug Sep Oct Nov
30%
37%
45%
65%
77%77%75%
82%
Percentof blood draws resulted by
8:00am
Pre-pre-
analytical
•Increaseawareness through daily huddles
•Priority units drawn earlier
•Phlebotomist TAT sheets &recognition for success
•Regular use of pneumatic tube for transport
Pre-
analytical
•Increaseawareness through daily huddles
•Realign shifts to match volume needs
•iLearn for RNs about proper specimen labeling
Analytical
•Increaseawareness through daily huddles
•Realign shiftto match workflow
•Tracker board to real-time monitor TAT
Achieving Optimal Laboratory Blood Testing
Turn-around Time for Effective Patient Care
Decisions: A Lenox Hill Hospital Experience
Frazon, S.; Rogers, R.; Walkwitz, J.; Vele,O.; Wahl, S.; Wranovics, D.; Sugrue, C.
Abstract: Lenox Hill Hospital Laboratory team improved the process of morning phlebotomy
draw turn-around time from 30% of results available by clinician rounds to 82% available in six
months. Using six sigma and change acceleration process methodologies to create a shared
vision of outstanding patient care, redirect focus on throughput, and evaluate staff schedules to
reflect test volume needs allowed success to be attainable without expending financial
resources.
Introduction: At an interdisciplinary task force at
Lenox Hill Hospital an external laboratory customer
brought to the attention of Laboratory Management
that a service they deemed critical to quality was not
being met: results from 5:00am morning blood
draws weren’t available for clinician rounds at
8:00am. Baseline data confirmed only 30% of tests
were resulted in time for clinician rounds and the
majority of blood draws were not received in the
laboratory until after 7:30am. It was decided to
focus laboratory efforts on blood draw turn-around-
time to allow 80% of 5:00am blood draws to be
resulted by 8:00am.
Material and method: After hearing the Voice of the customer, the stakeholders and front-line
staff created a shared need and vision: to provide optimal service to our physician and patient
customers by having results available by 8:00am. Front line staff drove the creation of a process
map and brainstorming of possible solutions throughout the process - including the pre-pre-
analytical (physician ordering, draw assignment and collection by phlebotomy, and specimen
transport), pre-analytical (specimen accessioning), and analytical phases.
Standardization of the process among phlebotomists of using the pneumatic tube every 30
minutes and at the completion of each unit was the biggest indicator for getting all specimens
into the laboratory in a timely manner. Analyzing specimen volume and workflow made clear
that a better utilization of labor was needed to meet our goal and employees were eager and
willing to realign their daily schedule to better match volume demands.
Results/Conclusion: Lenox Hill Hospital Laboratory was able to meet the goal of 80% of morning
blood draw specimens available by 8:00am
within six months. The largest increase came
after mid-July when all staff schedules were
changed to reflect daily demand.
Sustaining the Process: Turn-around time
continued to be monitored since the goal of 80%
was reached in November 2014. Despite heavy
staff and leadership turnover in Q1 of 2015,
year-to-date seventy-five percent of morning
draws have been resulted by the 8:00am goal
with the past three months all exceeding 85%.