Our goals were to improve the overall patient experience and optimize the blood collection process in outpatient phlebotomy using Lean principles. Elimination of non-value-added steps and modifications to operational processes resulted in increased capacity to handle workload during peak times without adding staff. The result was a reduction of average patient wait time from 21 to 5 minutes, with the goal of drawing blood samples within 10 minutes of arrival at the phlebotomy station met for 90% of patients. In addition, patient satisfaction increased noticeably as assessed by a 5-question survey. The results have been sustained for 10 months with staff continuing to make process improvements.

Ensuring accurate patient identification is central to preventing medical errors, but it can be challenging. We implemented a bar code-based positive patient identification system for use in inpatient phlebotomy. A before-after design was used to evaluate the impact of the identification system on the frequency of mislabeled and unlabeled samples reported in our laboratory. Labeling errors fell from 5.45 in 10,000 before implementation to 3.2 in 10,000 afterward (P = .0013). An estimated 108 mislabeling events were prevented by the identification system in 1 year. Furthermore, a workflow step requiring manual preprinting of labels, which was accompanied by potential labeling errors in about one quarter of blood "draws," was removed as a result of the new system. After implementation, a higher percentage of patients reported having their wristband checked before phlebotomy. Bar code technology significantly reduced the rate of specimen identification errors.

Point-of-care (POC) instruments employing fingerstick whole blood to monitor patients treated with warfarin are a popular alternative to complex, central laboratory coagulation analyzers utilizing citrated plasma derived from venipuncture. We investigated the accuracy of two widely utilized POC instruments for oral anticoagulation monitoring compared with a central laboratory instrument. Instrument-to-instrument variation differed for the two POC instruments, which correlated with the central laboratory instrument, but exhibited positive bias of 0.

Reallocating staff to match the pattern of demand for phlebotomy collections throughout the day represents a strategy for improving the performance of an inpatient phlebotomy service.

We found several benefits of implementing an electronic specimen collection module, including decreased wait and service times, improved patient satisfaction, and a reduction in preanalytical errors.

- An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

Implementation of a customized specimen collection module led to a significant reduction in preanalytical errors. Improved compliance with the system may lead to further reductions in error rates.

Context.-Short patient wait times are critical for patient satisfaction with outpatient phlebotomy services. Although increasing phlebotomy staffing is a direct way to improve wait times, it may not be feasible or appropriate in many settings, particularly in the context of current economic pressures in health care.Objective.-To effect sustainable reductions in patient wait times, we created a simple, data-driven tool to systematically optimize staffing across our 14 phlebotomy sites with varying patient populations, scope of service, capacity, and process workflows.Design.-We used staffing levels and patient venipuncture volumes to derive the estimated capacity, a parameter that helps predict the number of patients a location can accommodate per unit of time. We then used this parameter to determine whether a particular phlebotomy site was overstaffed, adequately staffed, or understaffed.Patient wait-time and satisfaction data were collected to assess the efficacy and accuracy of the staffing tool after implementing the staffing changes.Results.-In this article, we present the applications of our approach in 1 overstaffed and 2 understaffed phlebotomy sites. After staffing changes at previously understaffed sites, the percentage of patients waiting less than 10 minutes ranged from 88% to 100%. At our previously overstaffed site, we maintained our goal of 90% of patients waiting less than 10 minutes despite staffing reductions. All staffing changes were made using existing resources.Conclusions.-Used in conjunction with patient waittime and satisfaction data, our outpatient phlebotomy staffing tool is an accurate and flexible way to assess capacity and to improve patient wait times.(Arch Pathol Lab Med. 2014;138:929-935; doi: 10.5858/ arpa.2013-0450-OA) S everal studies have shown that patient wait times have a significant influence on patient satisfaction in the outpatient phlebotomy setting.1-3 A College of American Pathologists Q-Probes study involving 29 467 outpatients from 540 institutions showed that increased patient wait time for phlebotomy services was significantly correlated with lower patient satisfaction with the phlebotomy procedure. 4 When using outpatient phlebotomy services at our institution, patients follow a multistep process that includes checking in with their requisition form, entering their name and arrival time into a log book, and waiting to be called in. Likewise, phlebotomists must perform a series of tasks before seeing the patient, including entering providers' orders into the laboratory information system and printing out specimen labels (Figure 1). Inadequate phlebotomy staffing could increase patient wait time and decrease patient satisfaction. Although increasing staffing levels is the most direct way to improve patient wait times, it may not be feasible or appropriate in many settings, particularly in the context of current economic pressures in health care.In recent decades, many clinical laboratories have introduced Lean and Six Sigma process improvement principles.2,5-7 Sev...