Improving communication between phlebotomists and doctors: a quality improvement project

Abstract

Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management.We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the "Phlebotomy Box," a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre-and post implementation of the phlebotomy box.Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance.In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic, sustainable intervention that could be easily replicated in other Trusts. PROBLEMBlood tests are a seemingly basic investigation, but are often a vital part of directing patient management. The inpatient phlebotomy service at the Royal United Hospital (RUH), Bath, UK, is a daily service which relies on effective communication between the phlebotomy team and ward-based healthcare professionals. The service currently covers approximately twenty separate hospital wards, and serves a proportion of the Royal United Hospitals Bath NHS Foundation Trust's patient capacity of 565 beds.Blood stickers for patients who require blood to be taken are typically printed out in the afternoons, predominantly by junior doctors but also by nursing staff. These stickers are then left out for phlebotomist collection the following morning, with collected blood samples being sent to the laboratory for processing. Ideally the results are available by the early afternoon, allowing decisions regarding patient management to be made by their team within working hours.Despite the importance...

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