In-clinic Phlebotomists: A Patient Centered Solution to Improve Care and Quality Scores. (9th November 2022)

• Record Type: Journal Article
• Authors: Olson, J; Gingrich, D; Haynes, A
• Is Part Of: American journal of clinical pathology. Volume 158(2022)Supplement 1
• Page Start: S120
• Page End: S120
• Publication Date: 2022-11-09
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqac126.254
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Introduction/Objective: Phlebotomists play a central role in health care delivery, as the collection of a sample is the fundamental step in the performance of a laboratory test. Gaps between a patient's ideal care and the care they are receiving often include unperformed laboratory tests. For pediatric patients, screening for lead levels is recommended, and the percent of patients who complete this screening is a quality metric included in quality and HEDIS scores. The Laboratory Medicine Department, in conjunction with the Pediatric medicine department undertook an effort to increase the number of children compliant with this screening measure. Methods/Case Report: A pilot effort to increase screening rates was implemented in a large multispecialty ambulatory clinic building. Despite having a phlebotomy collection clinic directly across the hall from the pediatric clinic, an identified barrier to screening completion was patients leaving the pediatric clinic after a well-child exam and bypassing the laboratory collection site. The reasons behind this bypass were multifaceted, but the percieved inconvenience of making a second stop was identified as a major contributing factor. To improve this, a phlebomtist from the ambulatory collection clinic was assigned each day to go to the pediatric clinic whenever a blood draw was requested. The rates of screening were tracked for patients in this clinic pre- and post pilot. Results (if a Case Study enter NA): The rates of lead screening for 15 month-old pediatric patients in the population attributed to the pilot clinic went from an average of 38.1% in the pre-pilot phase, to 59.7% in the post-pilot phase, a statistically significant increase p=0.0021 . This workflow was also noted to be a patient satisfier for both patient family and clinic teams. Conclusion: Phlebotomy performed in a clinic room, immediately after a patient's clinic visit improved compliance with lead screening. This can be attributed to patient's willingness to have the care 'come to them' rather than needing to make a perceived 'second stop'. Although this workflow was a slightly less efficient for phlebotomists, the daily number of draws was not overwhelming and the increased satisfaction for patient families was judged a reasonable trade off. This workflow is expected to be utilized at other multispecialty clinics in our health care system. This project demonstrated that by making small improvements in workflow, the laboratory can have a significant impact on quality metrics and satisfaction.