Improving phlebotomy handover of untaken blood tests to junior doctors

Abstract

A lack of communication between junior doctors and phlebotomists means untaken blood tests are often not recognised until late in a junior doctor's day, resulting in additional hours worked, delays in patient management, and potentially avoidable handover of additional work to oncall doctors.We set out to improve communication, with an aim that ward doctors should be made aware of patients who have not been successfully bled by phlebotomists by 1:00pm. By introducing a formal handover clipboard in a designated ward space, we facilitated communication between phlebotomists and doctors, and minimised the potential for unrecognised "missed" blood tests.Our intervention was met with approval; 88% of junior doctors surveyed stated they found the clipboards useful, and 74% have noticed an improvement in communication, working efficiency and better patient safety. Post-intervention, junior doctors knew about 70% of booked blood tests that had not been taken by 1:00pm, compared to 26% pre-intervention. By allowing the recognition of missed blood tests to be noted early enough in the day for repeat samples to be taken, and the results to be acted upon, we feel our intervention has been a success. As a group of new foundation doctors we have felt empowered that as a result of recognising a problem, implementing simple changes, and monitoring results we have made a genuine improvement to multi-disciplinary team working, workload of junior doctors, and patient safety. ProblemWe have identified an ongoing problem in Southmead Hospital, Bristol, UK regarding the communication between the junior doctors and phlebotomists. Patients are regularly not being bled by phlebotomists for various reasons; the patient may be away from the bedside during the phlebotomy round, or phlebotomists may struggle to take blood from patients with difficult IV access.However, junior doctors often don't find out about missed samples until late in the day when they go to check the day's blood results.This often means that there is not enough time to bleed the patients and get results back before the end of the working day. This can be dangerous for patients since it means that important treatment can be delayed. Often it also leads to longer hours worked by doctors if bloods need to be repeated and treatment initiated later in the day.Additionally, this can mean an increase in the workload handed over to the already busy on-call team in the evenings.There is a clear need to improve phleobotomists handover to junior doctors about patients who haven't been bled that day.Aim: Junior doctors should be made aware of patients who have not been successfully bled by phlebotomists by 1pm.

Improving communication between phlebotomists and doctors: a quality improvement project

“…This appears congruent with the existing literature, the results of which support the introduction of standardised communication points. [1][2][3] A significant improvement in communication and efficiency within the phlebotomy service has been demonstrated, with tangible benefits to care. Given its affordability and simplistic design, the Phlebotomy Box represents an easily sustainable intervention which could easily be replicated in other Trusts, particularly when supported by long term managerial staff.…”

“…Previous similar projects, both locally in Bristol and nationally in London, had identified similar "frustrations" with their current services. [1,2,3] Throughout all the projects the issue of effective communication appeared to lie at the root of the problem. Indeed, Brown et al reported that 96% of junior doctors felt more could be done to improve phlebotomy/doctor communication, although it was not stated how many doctors were included in this survey, and no feedback was sought from the phlebotomy staff.…”