Emory Study Highlights Importance of Centralized Phlebotomy
Dedicated phlebotomy improves the quality of patient care in the Emergency Department (ED) setting. So says Emory Healthcare in Atlanta, GA, based on the outcomes realized from an initiative aimed at alleviating ED congestion by the addition of a laboratory phlebotomist.
During the first phase of a two-part study, dedicated phlebotomists were assigned to the ED weekdays from 2 pm to 10 pm, during peak patient workload hours.(1,2) Assigned phlebotomists were tasked with drawing ED patient samples and assuring samples were given priority by the testing laboratory. In addition, phlebotomists performed support services for ED clinicians, such as tracking and follow up on laboratory reports.
Data gathered during the survey period consisted of ED patient encounters where at least one of the following tests was ordered: CBC count, chemistry panel, prothrombin time (PT), troponin or blood culture. During the study, measured indicators of patient care included laboratory turnaround times and specimen quality.
Turnaround times for four of the tests (CBCs, chemistry panels, PTs and troponins) were calculated from the time of order request to results reporting, comparing total turnaround times for each test with baseline data, which was collected from non-laboratory personnel for six months prior to the study’s launch. A turnaround time of less than one hour was set as the goal for each of the four tests, with blood sample collection and transport estimated to require 20 minutes.
Figure 1 compares total turnaround times for the hospital’s calculated baseline and ED phlebotomist collections. Times shown represent the 90th percentile total turnaround time from order to result reporting.
When blood samples were collected by dedicated phlebotomists, ED patient wait times to be seen by a physician were also reduced by 24 minutes when compared to collections performed by non-laboratory personnel on the same shift.(2)
In summary, outcomes from the study include:(1,2)
The findings of the study conducted by Emory Healthcare were published in American Journal of Clinical Pathology in 2008, and were presented during an American Association for Clinical Chemistry (AACC) webinar in 2010.(1,2)
Ernst Appointed to CDC Best Practices Panel
The Center for Phlebotomy Education's Executive Director, Dennis J. Ernst MT(ASCP) has accepted an invitation to participate in the CDC Laboratory Medicine Best Practices (LMBP) Expert Panel on Reducing Blood Sample Hemolysis in Emergency Departments.
One role of the Evidence Review panel in which Ernst will participate is to recommend and review summaries of published and unpublished evidence about the effectiveness of specific practices on reducing emergency room hemolysis, and suggest recommendations about adopting these practices. The panel will also guide CDC staff in identifying practices, refining the research questions, and specifying relevant process or patient outcome measures.
The LMBP initiative was launched in 2006 by the CDC, Laboratory Science, Policy and Practice Program Office to develop new evidence-based review and evaluation methods for identifying pre- and post-analytic laboratory medicine practices that are effective at improving health care quality.
This is the second CDC Best Practices Expert Panel in which Ernst has participated. Last year's participation on a panel focusing on blood culture collection and patient identification led to the establishment of the following best practices:
Phlebotomy Today-STAT! will report the outcome of the panel's best practices recommendations when released by the CDC.
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 12th year of publication, are reading about this month:
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CLSI Publishes New Standard on Specimen Labels
Last month, the Clinical and Laboratory Standards Institute (CLSI) released Specimen Labels: Content and Location, Fonts, and Label Orientation (AUTO12-A), a new standard aimed at reducing human errors associated with non-standardized methods of sample labeling. The creation of this standard was prompted by published literature regarding the high rate of mislabeled specimens in U.S. laboratories.
Each year, more than 160,000 adverse events occur in the U.S. as a result of laboratories testing misidentified specimens. An estimated one in 18 identification errors leads to some type of negative event for the patient. It is clear that specimen identification errors contribute to patient safety issues across all laboratory disciplines. Until now, no standard format has existed for clinical laboratory specimen labels.
The document identifies essential information that must appear on specimen labels, as well as how the information should appear on the label, promoting consistency in formatting. Laboratories and healthcare providers who adopt this standard will help decrease the number of mislabeled samples, improving the quality of patient care through more timely and accurate patient test results.
CLSI is a volunteer-driven, membership-supported, nonprofit organization dedicated to developing standards and guidelines for the healthcare and medical testing community through consensus, balancing the perspectives of industry, government, and healthcare professions.
Q: What is the difference between using the thumb versus the index finger to hold the gauze in place when withdrawing the needle?
I like the students to use the index finger because:
A: This could be argued either way. The index finger seems more like the natural way to apply pressure. Using the thumb sounds awkward. Since nothing is written on it, it's personal preference. Your rationale makes perfect sense.
Each month, PT-STAT! will publish one of the hundreds of phlebotomy FAQs in the growing database of questions and answers available in Phlebotomy Central, the members-only section of the Center for Phlebotomy Education's website. For information on joining Phlebotomy Central, click here.
Last month, visitors to our website were asked how policies at their facilities impact personal job performance. Eighty-three percent of respondents indicated that the policies in place help them perform at their highest level, while 17 percent consider facility policies to be a deterrent to carrying out their duties.
When asked how closely they adhere to their facilities’ policies, the vast majority of survey participants believe in playing (and working) by the rules (94%), stating that they follow facility policy without exception.
When it comes to policy enforcement, nearly two-thirds of respondents stated that policies at their facilities are strictly and consistently enforced, while 35% indicated that violations often go unaddressed or policies are randomly applied (see Figure 2.)
What Should We Do?
[Editor’s Note: "What Should We Do?" gives you the opportunity to ask our team of technical experts for advice on your most pressing phlebotomy challenges. Whether technical or management in nature, we'll carefully consider solutions and suggestions based on the industry's best practices so that you and those in other facilities with the same problem can benefit, all the while maintaining your facility's anonymity. What Should We Do? is your opportunity to ask us for suggestions on the best way to handle your real-life dilemmas.]
While clearly the facility's counsel needs to assess the legal aspects of the situation, in our opinion, phlebotomists are not the ones who should have been put to the task of blood specimen collection. If attempted, such a draw could be emotionally traumatic for the phlebotomist, not to mention being beyond their job description and training.
Blood is not generally drawn from a corpse unless it is done by the medical examiner and that is usually a direct cardiac draw. Peripheral blood draws won't be easily done. The primary issue with the case presented would be to determine if an exposure occurred, then proceed as if the source was unknown. Post-exposure prophylaxis would be provided based upon the risk of exposure and immunization status of the exposed first responder. The protocols for this situation would be no different from any other time when blood from the source individual could not be immediately obtained.
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