Seeking perfect harmony between quantity and quality
by Dennis Ernst • May 06, 2020
How many patients should phlebotomists be expected to draw per hour? As you might expect, it depends. What can be reasonably expected from one employer is not likely to be an appropriate expectation somewhere else. That's because every facility has its own unique variables that can't be fairly applied anywhere else. Those variables include the use of a pneumatic tube system, the distance for the collector to travel to and from the patient, the percentage of difficult draws due to varying patient types, test/patient complications, etc. All of these and more must be factored whenever assessing the productivity of any specimen collection staff. Because it's been a while since Phlebotomy Today did a literature review on phlebotomy productivity, this article explores new and previously discussed studies from peer-reviewed journals.
Clinical Leadership Management Review
Researchers in Hong Kong audited the turnaround time (TAT) of their phlebotomy service to see if they were satisfying the needs and expectations of external and internal customers.(1) A survey form was given to phlebotomists to provide data using the honor system. Out of 1,867 phlebotomy requests received by the laboratory, the average time phlebotomists recorded that it took to respond to the request and draw the blood sample was 23.4 minutes. Breaking it down, it took an average of 7.4 minutes to “respond” to the request, 5.6 minutes to arrive at the patient, and 10.4 minutes to complete the draw. Ninety-seven percent of the draws were completed on the first attempt.
Canadian Journal of Emergency Medicine
Twenty-three minutes for a routine inpatient might be considered acceptable in some facilities, but what about emergency department (ED) patients? One study timed nurse-draws in the ED and found that it took 11 minutes on average between the time the test was ordered and the collection was complete.(2) The turnaround time for reporting hemoglobins from the time of collection to the time of resulting was 18 minutes. Potassiums were turned around in 49 minutes.
LabMedicine (2 studies)
The author of an article in LabMedicine shared how a phlebotomy system linking phlebotomists on the floor with the laboratory information system (LIS) increases the staff’s efficiency and patient safety.(3) Despite the focus of the study (efficiency and safety), it revealed interesting statistics on the amount of time required to draw inpatients once they arrived at the bedside. Without the use of the linked system, phlebotomists could collect a patient in three minutes versus 4.5 minutes with the system's handheld device. However, the linked system reduced collection errors that were costing up to 45 minutes of lost productivity.
Can your phlebotomists draw patients in 3 minutes? Should they? Given the amount of time it takes to perform hand hygiene and post-venipuncture care, is it even possible? Not according to researchers at the UCLA Medical Center. They found a more realistic estimate for entering and leaving an inpatient’s room is closer to six minutes.(4) Twenty-five percent of patients in the study required less than 5 minutes, and ten percent required more than twenty-one minutes. Although the study is a bit dated (1992), it provides the most detailed study on record as to how long a venipuncture should take.
In a second LabMedicine article, a team of researchers at Calgary Laboratory Services in Calgary, Alberta published a study that provides a far more reliable benchmark than hearsay.(5) The authors set out to establish the distribution of phlebotomy "cycle times" at four acute care hospitals in Calgary. One-hundred and ten phlebotomists, separated into groups according to their experience, were observed performing four to six phlebotomies each. Each procedure required the successful completion of 14 steps, including hand hygiene (before and after), applying pressure post-venipuncture, and donning gloves. Transit times going to and from the patient and laboratory were not included. The average time to perform the required steps of a routine, uncomplicated venipuncture was four minutes, nineteen seconds per patient with a standard deviation (SD) of 52 seconds.
The 52-second SD allowed them to recommend an acceptable range for performing a venipuncture to be between 3:16 and 6:44, or ten patients every hour, not including travel to and from the patient's location.
Archives of Pathology and Laboratory Medicine (5 studies)
Ten minutes per patient is exactly what researchers at Brigham and Women's Hospital in Boston also determined to be realistic for 90 percent of their outpatient draws as reported in CAP Today.(6,7) At the time of the study, the hospital had a total of 38 outpatient phlebotomists covering 14 outpatient draw sites. Collectively, the staff performed approximately 150,000 venipunctures per year. The study's authors created a staffing tool based on their outpatient volume and the number of available phlebotomists to accurately assess staff capacity and improve patient wait times to ten minutes or less.
Setting your own productivity benchmark
Every healthcare facility has a mix of those who are seasoned in the procedure and those who are new. Seasoned personnel are so comfortable with the procedure they barely have to think about it. They gracefully move from step to step as fluid and natural as a well-crafted poem. They’re on auto-pilot. Those new to the procedure, however, are more calculating and deliberate. They spend more time between steps mentally processing what comes next. Expecting the same productivity from those new to the procedure as from seasoned personnel would be unreasonable. Therefore, any estimate on the duration of a phlebotomy procedure must consider the individual’s expertise. Failure to do so risks an overly stressed staff that feels pressured to cut corners. It must also take into consideration the type of procedure (venipuncture versus capillary), and complications that might arise. Therefore, much goes into establishing an internal benchmark for phlebotomy-staff productivity if it is to be fair and reasonable.
Some argue the best way for a facility to establish its own expectations is to conduct an internal survey that takes into consideration the facility’s unique variables. Establish a workload benchmark by conducting a study that takes into account the variables that are unique to your facility. Set up a study that times your staff in the performance of their regular duties according to the standards, your facility’s procedure, and the CDC’s handwashing guideline recommending hand cleansing between patients. Determine exactly when the procedure begins (e.g., the time of the order, the time the employee leaves the lab or the time they arrive at the patient’s side). Then define what constitutes the end of the procedure (e.g., bandaging and leaving/dismissing the patient). Include a wide variety of personnel with a wide variety of experience at a wide range of times during the day.
Conduct an internal assessment. Include seasoned and new staff, venipunctures and skin punctures, and a variety of patient locations and types. Consider tracking draws with vastly different dynamics separately. For example, the time it takes to complete oncology and neonatal venipunctures should not be logged with uncomplicated venipunctures; capillary draws should not be tracked with venipuncture times. Make sure the staff is completing every step of the procedure, including hand hygiene between patients. Unless the procedure is standardized throughout the facility, the benchmark will be flawed.
- Leung AC, Li SW, Tsang RH, Tsao YC, Ma ES. Audit of phlebotomy turnaround time in a private hospital setting. Clin Leadersh Manag Rev. 2006 May 30;20(3):E3.
- Fernandes CM, Worster A, Hill S, McCallum C, Eva K. Root cause analysis of laboratory turnaround times for patients in the emergency department. CJEM. 2004 Mar;6(2):116-22.
- Sullivan E. Hospital automates phlebotomy department for efficiency and patient safety. Lab Med. 2005:36(9):528. Accessed 5/4/2020
- Howanitz PJ, Steindel SJ, Cembrowski GS, Long TA. Emergency department stat test turnaround times. A College of American Pathologists' Q-Probes study for potassium and hemoglobin. Arch Pathol Lab Med. 1992 Feb;116(2):122-8.
- Jones K, Lemaire C, Naugler C. Phlebotomy cycle time related to phlebotomist experience and/or hospital location. LabMed 2016;47(1):83–86.
- O'Reilly K. Lab shoots for better phlebotomy service, satisfied patients. CAP Today. 2016;30(3).
- Mijailovic A, Tanasijevic M, Goonan E, Le R, Baum J, Melanson S. Optimizing Outpatient Phlebotomy Staffing: Tools to Assess Staffing Needs and Monitor EffectivenessArch Pathol Lab Med. 2014;138(7):929-35.
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