American Military University Belated Lab Test Case Study

CASE OF THE BELATED LAB TESTS

PROCESS IMPROVEMENT OPPORTUNITY – PART 3

CAHIIM Competency Assessed:

Subdomain III.H. Information Integrity and Data Quality

3. Apply quality management tools

4. Perform quality assessment including quality management, data quality, and identification of best practices for health information systems (Blooms 4)

The Team went back to the data collection forms and created this data table of Phlebotomy turnaround times.

KEY:

TAT – turnaround time

MF – Monday through Friday

SS – Saturday and Sunday

D- Day

E – Evening

N – Night

SPECIMEN

TAT

TEST

DAY

SHIFT

FLOOR

1.5

CBC

2.0

LYTES

4.0

CBC

BUN

4.5

LYTES

1.0

GLC

3.5

CBC

2.0

LYTES

4.5

CBC

2.5

CBC

5.5

CBC

1.0

BUN

4.5

LYTES

2.0

GLC

4.5

GLC

4.5

CBC

1.5

LYTES

2.0

BUN

5.0

GLC

2.5

CBC

4.5

GLC

3.0

CBC

0.5

LYTES

5.0

LYTES

0.5

CBC

1.0

LYTES

4.0

LYTES

1.5

CBC

1.0

BUN

4.0

GLC

2.0

GLC

3.0

CBC

2.5

LYTES

2.0

GLC

5.0

CBC

1.0

CBC

1.5

LYTES

4.5

BUN

2.0

CBC

4.0

LYTES

2.0

LYTES

3.5

CBC

2.5

BUN

1.5

GLC

4.5

BUN

1.5

CBC

3.0

BUN

2.0

GLC

4.0

CBC

1.0

LYTES

2.0

CBC

5.0

LYTES

2.0

GLC

4.5

GLC

2.5

GLC

2.0

LYTES

5.0

CBC

2.5

BUN

1.5

GLC

2.0

CBC

4.5

BUN

0.5

LYTES

4.5

CBC

3.0

CBC

2.0

GLC

4.0

GLC

2.5

LYTES

3.5

GLC

4.5

LYTES

1.0

CBC

Assignment #1:

Put this data into an Excel spreadsheet and create multiple graphs that will show the relationship between TAT and the other factors. HELPFUL HINTS: TAT should be your vertical side of the graph. You will want a graph with Test, Shift, Day and Floor data displayed on the horizontal side of your graph. You will create 4 separate graphs.
1. You want the graphs to actually tell you something – they should show exactly where there are issues.
2. The first graph is comparing the type of tests, so you need to separate the data out by Test. You should find an average TAT for each type of test and put that in a table and graph it and see if it gives you some good information. So up the side you would have TAT and across the bottom you would just have 4 bars – one for each type of test.
3. Same thing for day of the week data. Average the TAT for MF and average the TAT for SS and put that into a table and graph it. So again the TAT will be up the side and then you will have two bars, just one for MF and one for SS. This way you can see if there is a difference in the TAT for these two. You will do the same with shift and floor.
4. There is an example with pretend numbers available to you
Describe what your graphs are showing you.

After viewing the graphs the team decides they need more information about the night shift……..

Interview With the Night Phlebotomist

Preface: The team decided a visit to the night shift or a discussion with the night phlebotomist (Dave Stick) would help to find some answers. The Assistant Administrator (Lotta) volunteered to talk to Dave. The Quality Advisor (Tom) thought it would be a good idea to join her.

——–CURTAIN UP—————–

Lotta: We have a big problem with the turnaround time for urgent lab tests here at the hospital, and the Quality Council has put together a PI team to work on this. Since the lab is part of my organization, I’m the team leader. We’ve studied this problem and found that blood-drawing for urgents on the night shift takes too long. We set up this meeting with you today to find out what’s going on.

Dave: What’s the Quality Council?

Lotta: It’s the hospital management, and they’re really concerned about urgent test turnaround times. Can you tell us why phlebotomy takes so long at night?

Dave: (getting defensive) I don’t know. Why don’t you talk to the floor secretaries? I hear they’re always slow at night. It’s certainly not my fault!

Tom: Maybe we should explain things a little more. There’s something about the process of drawing urgent specimens at night that seems to take longer than on the other shifts. We think there may be something different about the process and maybe we could think of ways to improve it if we understood it a little better. You’re the expert, so we’re talking to you. Could you help us understand what you do?

Dave: (relaxing a little) Well, everything’s different around here at night. You should come and visit us some time. I’m the only phlebotomist on duty and I’m on the run all the time. There used to be two of us, but, then there was the last round of cut backs. I think we need more night staff! You should tell THAT to your Quality Council!

Tom: You might be right – we may end up hiring more staff, but we can’t decide that without knowing more about the problem. Tell us about drawing blood at night.

Dave: Well, there are two of us in the lab at night, myself and one tech. I draw all the bloods and help out with the testing when I can. The phones are mostly answered by the Tech. She takes the request for a blood test and records it on a log sheet, by the floor. If it’s a STAT request, I go right out.

Lotta: What about the Urgents?

Dave: Those get called in, too. But, I can’t go running for them all the time. When I go out for a STAT, I do any urgents in that unit as well. Then, near the end of my shift, I go around to all the floors and draw the rest of the urgents and the routines, too. Anyway, after I do the draws, I bring the specimens down to the lab and leave them with the techs. Have you talked with the night tech?

Tom: we can do that if we need to. But, let me make sure I understand what you’ve told us so far. You go right out when a STATs called in and while you’re in the unit you take care of any urgents that are there. When an urgent’s called in, you don’t go right out, but at the end of your shift, you make a sweep of the units and take care of both the urgents and routines. Do I have it right?

Dave: That’s it. We used to go out for the urgents just like the STATs before the last cuts. After that, with just me on nights, we couldn’t do that. I told my supervisor about that and he said it was OK, if that was the best we could do.

Lotta: Harry agreed with that? I wonder why I didn’t know.

Dave: No, not Harry – the guy before him. I think he left and went to Valley Hospital. Look, I’m serious. There are lots of things that are done a little differently on the night shift.

Tom: I’m sure you’re right! One more thing. What do you know that’s special about units 3B and4A?

Dave: Oh, those. That’s Diagnostic Med and Psych. They have very few requests at night, and just about zero STATs. I never make a special trip up there. I’m telling you, we just don’t have the time to run out for every test at night. Besides, if they really want the results in a hurry, they order them STAT. If that Quality Council wants special runs for everyone, they’ll just have to bite the bullet and hire more night staff.

Tom: Well, I think you’ve given us a pretty clear picture. We really appreciate your being so frank with us. I wonder if you’d be willing to join our project team. What do you think?

Dave: That would be great. Us night people don’t get a chance to be involved in lots of things that go on during the day.

Lotta: I realize that. We could move our meetings to the first thing in the morning. And, I’ll see to it that you’re paid for the time.

——-CURTAIN DOWN—————

Assignment 2:

Critique this interview. What was done well? What was not done so well?
Where is the team in the problem solving process?

American Military University Belated Lab Test Case Study

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