Optimizing Outpatient Phlebotomy Staffing: Tools to Assess Staffing Needs and Monitor Effectiveness

Abstract

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...

Adaption, implementation and evaluation of collaborative service improvements in the testing and result communication process in primary care from patient and staff perspectives: a qualitative study

“…In many countries, same day access to phlebotomy is expected and provided [ 28 ], yet both patients and staff at our study practices previously reported regular and frequently lengthy waits for an appointment with a phlebotomist [ 6 , 7 ]. Some of the failure to match practice resource to patient need can be attributed to the variability of demand inherent in healthcare provision, and can be mitigated by strategic management interventions [ 29 ].…”

The Economic Impact of Levothyroxine Dose Adjustments: the CONTROL HE Study

“…Each specialist visit was estimated to be 122 min in average duration. This assumes a slightly longer time with the clinician (21 min) vs. a non-specialist physician (20 min), as studied by Shaw et al [39] Hospitalization (inpatient)Cardiac cases: $882.56Non-cardiac cases: $554.75Based on the $252.16-per-day value calculated by the FDA [36] and the estimated length of stay for cardiac-related hospital stays and non-cardiac stays from a 2014 study by Shaw et al (3.5 days for cardiac cases; 2.2 days for non-cardiac cases) [39] ED visit$141.84Estimated based on a 4.5-h duration and an average value of an hour’s lost work time of $31.52 per hour [37] Laboratory tests and imaging$18.48From an estimated 15 min of time required for a blood draw by a phlebotomist [40], plus an assumed 37 min of travel to the laboratory site (much like a physician office [38]), an average laboratory visit would take 52 min. Borrowing from the estimated time and cost of a physician visit above (121 min), the cost of the laboratory visit was calculated at $18.48

ED emergency department, FDA Food and Drug Administration, GI gastrointestinal, ob/gyn obstetric-gynecologic, TSH thyroid-stimulating hormone, T3 , triiodothyronine, T4 thyroxine

…”

The Economic Impact of Changing Levothyroxine Formulations in Difficult-to-Treat Hypothyroid Patients: An Evidence-Based Model

“…Lost productivity was calculated at a rate of $31.52/hour based on government and published sources ( Table 2). From an estimated 15 minutes required for a blood draw by a phlebotomist, [41] plus an assumed 37 minutes of travel to the laboratory site (similar to a physician's office), [38] an average laboratory visit would take 52 minutes. Borrowing from the estimated time and cost of a physician visit noted above (121 minutes), the cost of the laboratory visit was calculated at $18.48.…”