Achieving optimal laboratory testing turn-around-time for timely patient care decisions

1. Copyright 2010, All rights reserved
Achieving optimal laboratory testing
turn-around-time
for timely patient care decisions
Lenox Hill Hospital

2. Copyright 2010, All rights reserved
There was a perception that results from
morning phlebotomy rounds were not
available by the time Clinicians rounded
on their patients.

3. Copyright 2010, All rights reserved
Retrospective review of
April 2014 data
Only 30% of draw results available by 8:00am
0%
5%
10%
15%
20%
25%
30%
35%
7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM > 12:00PM

4. Copyright 2010, All rights reserved
Retrospective review of
April 2014 data (cont.)
• Period evaluated: April 1 to 30, 2014
• Order time: 100% before 12:00pm
• Blood collection time: 5:00am
• Samples: 10,316 tests ordered
• Samples received in the lab: 100% by
08:08am

5. Copyright 2010, All rights reserved
Creating a team Goal
Over the next six months (by the end of
November, 2014) improve turn-around-
times (TAT) to allow of 5:00am
blood draws to be resulted by
clinical rounds
80
%8:00a
m

6. Copyright 2010, All rights reserved
Understanding the process
(as of May 2014)
Pre-Pre-analytical Phase
Pre Analytical Phase
Analytical Phase
Phlebotomist sending blood at the
completion of each unit
Only one accessioner available when the
majority of blood specimens arrive (6-7am)
Additional accessioning responsibilities
Schedules of technologists did not
correspond to time of greatest need

7. Copyright 2010, All rights reserved
Means for improvement
Pre-Pre-analytical
• Increase
awareness
through daily
huddles
• Realign shifts
to match
workflow
• Phlebotomist
TAT sheets
• Pneumatic
tube every 30
minutes
Pre-analytical
• Increase
awareness
through daily
huddles
• Realign shifts
to match
workflow
• iLearn for
specimen
labeling
Analytical
• Increased
awareness
through daily
huddles
• Realign shifts
to match
workflow
• Tracker board
monitor for
specimen TAT

8. Copyright 2010, All rights reserved
Our Action Plans
Pre-pre-analytical Phase
Send bloods every 30 minutes and at
completion of each unit
Use paper “punch cards” to track TAT from
when the phlebotomist sends up specimen to
when they are accessioned
Shift the start time for drawing priority units
with two available phlebotomists

9. Copyright 2010, All rights reserved
Our Action Plans (cont.)
Pre-Analytical Phase
Change shift schedule so two accessioners
during busiest morning hour (6-7) and three
available thereafter
iLearn for specimen labeling to reduce
specimen defects and accessioning delays
(available January 2015)

10. Copyright 2010, All rights reserved
Our Action Plans (cont.)
Analytical Phase
Realign technologists’ schedules to
correlate with times of largest specimen influx
Tracker board for real-time TAT data
(available December 2014)

11. Copyright 2010, All rights reserved
SUMMARY OF SHIFT CHANGES

12. Copyright 2010, All rights reserved
30%
37%
45%
65%
77%77%75%
82%
62%
59%61%
76%77%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
8:00 AM
Hematology morning workflow
Tests Completed by 8:00am
Scheduling changes took effect

13. Copyright 2010, All rights reserved
LESSONS LEARNED
Schedules are a powerful resource
Asking for and listening to employee input
and recognizing employees for their
achievements creates buy in and
contributes toward team success
Staff is willing to make changes that
improve patient care

14. Copyright 2010, All rights reserved
Thanks to all Lenox hill Hospital
staff, Supervisors, Managers and Administration this
achievement
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