Over the Rainbow: Increasing Patient Safety and Satisfaction with Decreased Lab Draws

Purpose:
Previously, when emergency department (ED) nurses and technicians drew blood, a “full rainbow” consisting of 7 color blood tubes were filled majority of the time. The goal of the project was to reduce the number of blood tubes by using the patient's chief complaint as basis for blood collection.

Significance:
Extra blood tube collection resulted in reduction of blood sample integrity and increased hemolysis rate resulting in evaluation and treatment delays. Specimen recollection resulted in more venipunctures, increasing risk for infection and patient discomfort which reduced patient satisfaction.

Strategy and Implementation:
A multidisciplinary team of ED and lab personnel was formed. A list of common patient chief complaint with corresponding lab tests and required blood tubes was placed on a reference card worn with name badges(badge buddies)by all ED nurses and technicians. The cards were also placed in the lab trays and patient rooms. Staff training was made on the badge buddies and tube reduction initiatives during unit meetings and daily huddles. The team also streamlined few lab testing that could be performed in the same lab tube such as drug levels on a lime top tube instead of a red top. ED staff used to write their initials, date and time of collection on the tubes. To better identify the ED staff member who collected the extra tubes, it was changed from the staff initials to employee number. Close monitoring on the number of extra blood tubes collected is done by the lab weekly then monthly. ED supervisor reviews the data collected and coaches individual ED staff members as needed.

Evaluation:
The number of blood tubes was reduced by 60% exceeding the goal of 35% and hemolysis rate was reduced by 75%.It improved timeliness of results, reduced redraws and improved patient's comfort during blood draw on Press Ganey score. An annual savings of $20,000.00 is predicted by the end of 2012.

Implications for Practice:
ED and lab partnerships create an opportunity to improve processes resulting in increased quality and safety outcomes, increased efficiency, reduced waste, and financial savings. This process is adapted across the Baylor Health Care System and has a potential in all organizations nationwide.