Drastically cut turnaround times for lab results
ED cuts length of stay by 30 minutes
Are you struggling to cut delays in getting lab test results? Lab delays can have a dramatic impact on patient flow.
"Reduced cycle time allows for increased capacity to see patients, which increases revenue," says Maribeth Woitas, director of emergency services at North Memorial Medical Center in Robbinsdale, MN. "This also improves ED and lab relationships and increases both physician and staff satisfaction."
To cut delays in lab turnaround time, do the following:
• Examine every step in the process.
At North Memorial, the timeframe from when the need for a blood specimen is identified, until the results are available to the ED physician for clinical decision making, was broken down step by step, says Woitas.
"We found that the biggest improvement opportunity existed in the subprocess for when the order for lab test is written until the specimen is collected," she says. A new process was created, with the ED nurse determining during the initial assessment if the patient meets preapproved criteria for blood work.
From the patient’s bedside, the nurse pages the lab phlebotomist to do a criteria blood draw, obtain a blood sample, and log it into the computerized laboratory analysis system. "Therefore, when the physician orders the specific tests, the sample is already in the lab and they can begin the analysis," says Woitas.
The new process reduced length of stay for these patients by 30 minutes, she reports.
• Give feedback to individual nurses.
ED nurses weren’t consistently making the practice changes necessary to identify patients who met the criteria for blood draws, says Woitas. "So we proceeded to individually profile nurses and the percentage of time that they initiated criteria-based blood draws, in relationship to all of their patients requiring blood tests," she says.
The nurses’ performance was compared to department and shift averages. Each nurse received this data along with a letter that categorized their performance, as follows:
— Above department average. Nurses were congratulated for taking a leadership role in implementing the process change and encouraged to share their successful approach with colleagues.
— Consistent with department average. Nurses were encouraged to increase their awareness and more fully incorporate this change into their practice.
— Below department average. Nurses were encouraged to objectively evaluate their performance, find ways to incorporate this change into their daily practice, and secure assistance from their colleagues.
"Prior to individual performance profiling, we were not able to get consistently above 31% ED criteria draws," says Woitas. "As of December 2004, 71.9% of our lab order to draw’ were less than or equal to 12 minutes, with a 41.7% criteria blood draw rate. We believe that this is probably a best practice benchmark."
Pneumatic tubes designated for ED
• Identify ED labs as priority.
At Deaconess Hospital in Evansville, IN, a pneumatic tube system is used that only transfers specimens between the ED and the lab. "So they know if something comes in that tube, that it is a stat from the ED," says Diana Everley, RN, ED clinical educator. All blood from the ED is draw stat and run stat, Everley says. "We also have different labels than the rest of the hospital, which are white with a red stripe around them," she says. "This also alerts the lab that it is an ED tube."
When the ED receives a call for an incoming trauma patient, trauma pagers are activated. "Lab has one of these pagers and comes to the ED to get the blood," says Everley. "Many times the lab personnel are in the room, with the rest of the trauma team, waiting for the patient to arrive."
When a stroke patient is identified, a sticker is placed on the specimen saying "priority specimen," says Everley. "We are looking at mimicking this for our acute MI patients," she says.
LOS reduced by 25 minutes
• Use point-of-care (POC) testing.
At Children’s Hospital, POC testing has decreased length of stay by 25 minutes, with rapid strep, urinalysis, guiacs, and urine human chorionic gonadotrophin testing performed in the ED by nurses, says Barb Abdalla, clinical leader for the ED. "If a patient presents with a sore throat, the rapid strep test is performed prior to the physician exam." It normally takes about 30 minutes to obtain results from the lab, she adds. "It takes about five minutes to do the POC test in the ED."
It helps to have a designated person to do POC testing, says Abdalla. "We have a limited number of nurses trained, but all of our patient care assistants are trained," she says. "They are responsible for making sure the daily quality control tests are performed."
Sources
For more information on decreasing lab turnaround times, contact:
- Barb Abdalla, RN, Clinical Leader, Emergency Department, Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205. Phone: (614) 722-4225. E-mail: [email protected].
- Diana Everley, RN, Clinical Educator, Emergency Department, Deaconess Hospital, 600 Mary St., Evansville, IN 47747. Phone: (812) 450-7173. E-mail: [email protected].
- Maribeth Woitas, Director, Emergency Services, North Memorial Medical Center, 3300 Oakdale Ave. N., Robbinsdale, MN 55422-2900. Phone: (763) 520-5550. Fax (763) 520-7562. E-mail: [email protected].
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