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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...

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This study illustrates how continuous process improvement through Lean can optimise workflow, improve timeliness, and decrease error in inpatient phlebotomy. We believe this manuscript adds to the field of clinical pathology as it can be used as a guide for other laboratories with similar goals of optimising workflow, improving timeliness, and decreasing error, providing examples of interventions and metrics that can be tailored to specific laboratories with particular services and resources.

Introduction Evidence suggests that stand-alone pediatric trauma centers outperform adult and combined adult/pediatric trauma centers in limiting radiation exposure to injured children. We sought to determine the impact of implementing evidence-based guidelines for pediatric imaging at a combined adult (level 1) and pediatric (level 2) center. The initiative focused on trauma/critical care surgeons as the pediatric surgeons did not participate in the resuscitation and initial evaluation of injured children. Methods Imaging guidelines were developed from existing clinical studies. After 3 months of education, guidelines were implemented, and regular feedback was given to providers regarding compliance. Data were collected from the trauma registry for all pediatric patients (aged less than 15 years), in calendar years 2017 (pre-guideline) and 2019 (post-guideline). All admissions were analyzed, with subgroup analysis of children with multisystem trauma admitted to the trauma surgery service. Results Following guideline implementation, mean computed tomography (CT) scans per injured child fell by over 50% (.93 vs .45). For patients admitted to the trauma service, the mean fell by 58% (1.82 vs 0.76). The number of patients receiving more than 1 CT significantly decreased for all children (26% vs 10%), and particularly those admitted to the trauma service (52% vs 17%). During this time, there was only one injury missed at the initial admission, which was clinically insignificant (non-displaced skull fracture). Conclusions Implementation of evidence-based guidelines for imaging eliminates disparity in practices between a combined adult/pediatric trauma center and stand-alone pediatric trauma centers.

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Introduction: Both hyperkalemia and pseudohyperkalemia occur in the emergency department. True hyperkalemia necessitates emergent treatment while pseudohyperkalemia requires recognition to prevent inappropriate treatment. It is imperative that the emergency physician (EP) have an understanding of the causes and clinical presentations of both phenomena. Case Report: We present a case of an 88-year-old male with chronic lymphocytic leukemia (CLL) and suspected blast crisis who was found to have elevated serum potassium levels without other manifestations of hyperkalemia and eventually was determined to have pseudohyperkalemia due to white cell fragility. Discussion: Differentiation of hyperkalemia and pseudohyperkalemia is a critical skill for the EP. We discuss multiple causes of hyperkalemia and pseudohyperkalemia in an effort to broaden the knowledge base. Conclusion: We present a case of CLL as an unusual cause of pseudohyperkalemia and review common causes of pseudohyperkalemia.