Phlebotomy Services Research Articles

Assessment of Customer Satisfaction with the Clinical Laboratory Services Provided in King Abdullah Medical City, Makkah

Background: Patients and physicians are considered primary customers of laboratory services. Therefore, assessing customer satisfaction with laboratory services is an essential indicator in improving the quality of laboratory services. Objectives: This study measures the level of satisfaction of physicians and patients who avail of the clinical laboratory and phlebotomy services, respectively, at the outpatient department (OPD) in King Abdullah Medical City (KAMC), to evaluate the possible issues and carry out corrective actions. Methods: A cross-sectional survey to evaluate the level of satisfaction using a modified patient and physician questionnaires, the patients were randomly selected and interviewed in phlebotomy areas at the outpatient and chemotherapy clinics. A paper-based questionnaire was distributed to all physicians all available physicians in KAMC who were regularly requiring laboratory investigations. The collected data were coded, entered, and checked for outliers or missing data and analyzed using the SPSS statistical package version 21. Results: A total of 435 patients were interviewed and their mean satisfaction was 4.51±0.32 out of 5. Respondents were satisfied with the Availability of laboratory tests. However, they were dissatisfied with of the phlebotomy cautions by the (75.4%). Twenty eight percent of physicians (132) participated, their mean satisfaction rate was 3.6±0.7 out of 5. The greatest satisfaction rate was related to critical results notification and the communication with laboratory personnel. Physicians were most dissatisfied with both delivery and incorrect test results. Conclusion: Both customers were satisfied with the laboratory service provided for them. Factors as Explanation of the phlebotomy by phlebotomist and specimen collection and delivery process received lowest satisfaction score for patients and physicians respectively. Therefore, improving them is required to meet the needs of the customers and gain their satisfaction regarding the service.

Optimized staff allocation for inpatient phlebotomy and electrocardiography services via mathematical modelling in an acute regional and teaching hospital

Adhering to pre-defined service routes that cover a fixed set of wards in a shift, the inpatient phlebotomy service provides 24-hour coverage for a 27-storey, 1,400-bed hospital. We present an application of mathematical optimization to improve its service efficiency without injecting additional resources. A mixed integer programming model was implemented to revamp the service route configuration to minimize workload discrepancies among service routes, limit maximum daily workload per route and restrict routes to span a maximum number of floor levels, while taking into consideration the ward-specific demand for each duty (i.e. daytime, evening, and night time) throughout the day. This data-driven and evidence-based approach has facilitated an overhaul of the existing route configuration of the inpatient phlebotomy service, which resulted in a more effective and contented workforce, as well as a more efficient service with an evened-out workload among phlebotomists and increased time spent on direct patient care by phlebotomists. Subsequent scenario analysis revealed that more manpower on a micro-level is not necessarily better and highlighted the importance to strategically design duty hours and allocate manpower across different duties on a system level.

Evaluation of Phlebotomy Services in Clinical Laboratory Setting in Addis Ababa Public Hospitals, Addis Ababa, Ethiopia

Background: Phlebotomy is the system of drawing a blood sample for the use of laboratory testing and for blood transfusion. Professionals who are performing phlebotomy services called phlebotomists. It is a critical part of the pre analytical phase of laboratory testing and is the most neglected procedures in health care. About 70% of the quality of the test are affected during phlebotomy and other pre analytical services. However, little is known about the practice of phlebotomy services in developing countries like Ethiopia. Objectives: To assess the practice of phlebotomists and to identify the major sources of errors during venous blood collection in public hospitals in Addis Ababa. Methodology: Hospital based, cross sectional observational and follow-up study was conducted from March to May 30, 2014. The study followed 40 phlebotomists while each of them was collecting 5 different venous blood collections (giving a total of 200 phlebotomies). Well structured questionnaires and checklists were used to collect data. Data was entered on EPI-Data version 3.1 and statistical analysis was performed with SPSS version 20. Descriptive statistics were employed and the Chi square test was used for comparing major errors observed. Result: Almost all laboratory phlebotomy sites had no Standard Oprating Procedures (SOPs) available in collection sites and most of collection sites were not well ventilated. The major errors identified were use of single glove for more than one client 139 of 200 (69.5%), inappropriate cleaning practice of vein puncture sites 180 of 200 (90%), collecting blood before the disinfectant alcohol dried 139 of 200 (69.5%), incorrect tube collection sequences 107 of 200 (53.5%), unnecessarily applying of tourniquets after blood started flowing in to the collection tubes and syringes 170 of 200 (85.0%) and applying tourniquets before locating and selecting appropriate site for venous blood collection 175 of 200 (87.5%). Conclusion and Recommendation: -Many errors were identified in the phlebotomy practice during the observational study. As the quality of blood specimen influences patient result: emphasis should be given on phlebotomy training to improve the practices for phlebotomists and ensure safety as well as quality during blood collections for laboratory analysis.

Analysis of Patient's Satisfaction with Phlebotomy Services in NABH Accredited Neuropsychiatric Hospital: An Effective Tool for Improvement.

Patient's satisfaction is the need of the hour and one of the most important quality indicators in the laboratory medicine. To assess the patient's satisfaction with phlebotomy services in a neuropsychiatric hospital by a structured questionnaire with grading scale. Also, identify the problems causing dissatisfactions and to undertake necessary Corrective and Preventative Action (CAPA). Total 1200 patients were randomly selected over a period of two months (June and July 2016). A structured self designed questionnaire (feedback form) was devised in both Hindi and English languages containing ten questions with a grading scale for each question. It also included suggestions from the users. All the selected patients or their attendants filled up this questionnaire. At the same time, they were also interviewed by phlebotomy staff. A statistical analysis was conducted using SPSS version 16.0 software and Likert scale. A total of 94% of the patients were satisfied with the phlebotomy services. Almost 30.0% patients found the phlebotomy services to be very good, but the majority of them (40.5%) found it to be good and another 23.5% found it to be satisfactory while, 4% found the services to be poor and 2% found it to be very poor. The highest rate of satisfaction (4.21) was noted in case of parameter-ease to find collection sample room and lowest rate of satisfaction (3.92) was scored by the parameter-staff's wearing proper uniform. Depending upon the deficient areas some corrective actions were suggested such as strict compliance of personal protective equipments, regular training to improve technical skill, knowledge and behaviour with emphasis on cleanliness of work area. Even though the overall patient's satisfaction was high, there were areas which needed our attention such as waiting time for phlebotomy procedure, lack of proper sitting arrangement, techniques of sample collection, knowledge of universal precautions etc. Appropriate corrective and preventive actions were taken to solve the problems. Thereby, feedback proved effective in maintenance and improvement of phlebotomy services.

Pediatric Phlebotomy Services: Optimizing Sample Quality and Improving the Patient and Parent Experience.

The pediatric phlebotomy staff at every medical institution that serves children and babies meets challenges every day. After all, they are responsible for performing a procedure on one of our largest and most vulnerable populations that is invasive and can cause long-term negative effects, including reduced pain tolerance and avoidance of healthcare as an adult (1). There are effective techniques to improve the overall experience and reduce physiologic and psychological pain during blood collection (Table 1). Time is the primary barrier to using many of these techniques, and utilization rates suffer accordingly. To increase pain management utilization in pediatric patients at the Mayo Clinic, the appointment …

Improving communication between phlebotomists and doctors: a quality improvement project

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...

Impact of nurse-delivered community-based CD4 services on facilitating pre-ART care in rural South Africa.

BackgroundHIV testing, diagnosis and treatment programs have expanded globally, particularly in resource-limited settings. Diagnosis must be followed by determination of treatment eligibility and referral to care prior to initiation of antiretroviral treatment (ART). However, barriers and delays along these early steps in the treatment cascade may impede successful ART initiation. New strategies are needed to facilitate the treatment cascade. We evaluated the role of on site CD4+ T cell count phlebotomy services by nurses in facilitating pre-ART care in a community-based voluntary counseling and testing program (CBVCT) in rural South Africa.MethodsWe retrospectively evaluated CBVCT services during five continuous time periods over three years: three periods when a nurse was present on site, and two periods when the nurse was absent. When a nurse was present, CD4 count phlebotomy was performed immediately after HIV testing to determine ART eligibility. When a nurse was absent, patients were referred to their local primary care clinic for CD4 testing. For each period, we determined the proportion of HIV-positive community members who completed CD4 testing, received notification of CD4 count results, as well as the time to test completion and result notification.ResultsBetween 2010 and 2013, 7213 individuals accessed CBVCT services; of these, 620 (8.6 %) individuals were HIV-positive, 205 (33.1 %) were eligible for ART according to South African national CD4 count criteria, and 78 (38.0 % of those eligible) initiated ART. During the periods when a professional nurse was available to provide CD4 phlebotomy services, HIV-positive clients were significantly more likely to complete CD4 testing than during periods when these services were not available (85.5 % vs. 37.3 %, p < 0.001). Additionally, when nurses were present, individuals were significantly more likely to be notified of CD4 results (60.6 % vs. 26.7 %, p <0.001). The time from HIV screening to CD4 test completion was also significantly shorter during nurse presence than nurse absence (median 8 days (IQR 4–19) vs. 35 days (IQR 15–131), p < 0.001).ConclusionsThese findings indicate that in addition to CBVCT, availability of on site CD4 phlebotomy may reduce loss along the pre-ART care cascade and facilitate timely entry into HIV care.

Improving outpatient phlebotomy service efficiency and patient experience using discrete-event simulation.

Purpose - The purpose of this paper is to present a simulation modeling application to reconfigure the outpatient phlebotomy service of an acute regional and teaching hospital in Hong Kong, with an aim to improve service efficiency, shorten patient queuing time and enhance workforce utilization. Design/methodology/approach - The system was modeled as an inhomogeneous Poisson process and a discrete-event simulation model was developed to simulate the current setting, and to evaluate how various performance metrics would change if switched from a decentralized to a centralized model. Variations were then made to the model to test different workforce arrangements for the centralized service, so that managers could decide on the service's final configuration via an evidence-based and data-driven approach. Findings - This paper provides empirical insights about the relationship between staffing arrangement and system performance via a detailed scenario analysis. One particular staffing scenario was chosen by manages as it was considered to strike the best balance between performance and workforce scheduled. The resulting centralized phlebotomy service was successfully commissioned. Practical implications - This paper demonstrates how analytics could be used for operational planning at the hospital level. The authors show that a transparent and evidence-based scenario analysis, made available through analytics and simulation, greatly facilitates management and clinical stakeholders to arrive at the ideal service configuration. Originality/value - The authors provide a robust method in evaluating the relationship between workforce investment, queuing reduction and workforce utilization, which is crucial for managers when deciding the delivery model for any outpatient-related service.

Engaging diverse populations in biospecimen donation: results from the Hoy y Mañana study.

The disproportionately lower number of certain subpopulations participating in clinical and prevention research has a significant impact on the representativeness of scientific outcomes. The Hoy y Mañana program (Today and Tomorrow) was developed as a culturally and linguistically appropriate education program to engage diverse medically underserved populations without a cancer diagnosis in biospecimen donation for cancer genomic research. Participants were recruited to in-depth community-based educational programs (∼45-60-min duration) or during open events in the community based on a convenience sampling. Programs were offered in English and Spanish. An on-site mobile lab along with phlebotomy services was provided at all programs and events to collect participant biospecimen (blood) samples to be stored at the cancer center's Data Bank and BioRepository (DBBR). The distributions for education, race/ethnicity, and gender were similar across the event types. Most of the participants were women. The analysis sample had a total of 311 participants, including 231 from the education programs and 80 participants from open events. Those with a higher education (college or more) were more likely to donate than those with a lower level of education (high school or less) (45 vs 28%, p = 0.007). Actual donation status was not associated with age or race. Willingness to donate a biospecimen and biospecimen donation rates followed the same pattern with respect to participants with higher levels of education being more willing to donate and giving a blood donation. Prior to outreach efforts, less than 6% of specimens donated to DBBR from healthy/non-cancer patients were from minority participants.

Viewpoints of Patients in Qazvin Towards Complementary and Alternative Medicine

Background: We have little information on the degree of individuals’ in Iran and their use of complementary and alternative medicine, its variations and the causes of people’s tendency towards the treatments used in the methods mentioned above. Objectives: In 2012, we set out to study the viewpoints of patients in Qazvin, Iran, examining how they feel about complementary and alternative medicine. Patients and Methods: In a cross-sectional study, data were collected through the use of a questionnaire. A total of 293 patients who had been referred to the complementary and alternative medicine centers were surveyed. These centers practice methods such as cupping, homeopathy and acupuncture. The questionnaire was divided in two parts, demographic questions and main questions, in this particular study. The data were analyzed using SPSS software version 19 with P < 0.05. Results: The mean age of the participants was 37.2 ± 13.3, and 60.8 percent of them were men. In all, 70.6 percent and 24.4 percent of respondents were married and single, respectively. About 58 percent had completed their undergraduate education. The cause of 31.3 percent of the participants’ visits was mental sicknesses, 20.2 percent attended due to rheumatologic diseases, and 8.2 percent applied to the mentioned treatment centers seeking relief from skin-related diseases. Ninety-one percent of the participants reported using alternative and complementary medicine for its efficiency. The levels of high satisfaction they reported gaining from the center’s homeopathy, acupuncture, and phlebotomy services were 17.2%, 16.5%, and 18.2%, respectively. In addition, 70 percent of the patients found the new treatment method to be quite successful, while 27 percent found it to be less effective than other approaches they had tried. Conclusions: The people were receptive to the use of alternative and complementary medicine and their satisfaction level was high. Keywords: Homeopathy, Acupuncture, Phlebotomy

Use of Geospatial Mapping to Determine Suitable Locations for Patient Service Centers for Phlebotomy Services

Approaches to determining optimal locations for patient service centers (phlebotomy clinics) have not been addressed in the published literature. Using the city of Calgary, Alberta, Canada, as a test case, our objective is to present a novel method for determining underserviced geographic areas within a city to guide the choice of potential new patient service center locations. Data on travel distances for 198,883 phlebotomy visits as well as population data from the 2011 Canada Census were used for this study. Using geospatial mapping techniques, we produced maps of the city showing actual relative travel distances for patients as well as the geographic distribution of population density of patients undergoing phlebotomies. There was a striking pattern of increased travel distances in certain parts of the city. These also corresponded to geographic areas with greater density of patients seeking phlebotomies. This analysis provided clear, objective evidence of communities that are currently relatively underserved by patient service centers. This approach could be used by other laboratories to plan the location of new patient service centers.

Efficiency of an automated reception and turnaround time management system for the phlebotomy room.

BackgroundRecent advances in laboratory information systems have largely been focused on automation. However, the phlebotomy services have not been completely automated. To address this issue, we introduced an automated reception and turnaround time (TAT) management system, for the first time in Korea, whereby the patient's information is transmitted directly to the actual phlebotomy site and the TAT for each phlebotomy step can be monitored at a glance.MethodsThe GNT5 system (Energium Co., Ltd., Korea) was installed in June 2013. The automated reception and TAT management system has been in operation since February 2014. Integration of the automated reception machine with the GNT5 allowed for direct transmission of laboratory order information to the GNT5 without involving any manual reception step. We used the mean TAT from reception to actual phlebotomy as the parameter for evaluating the efficiency of our system.ResultsMean TAT decreased from 5:45 min to 2:42 min after operationalization of the system. The mean number of patients in queue decreased from 2.9 to 1.0. Further, the number of cases taking more than five minutes from reception to phlebotomy, defined as the defect rate, decreased from 20.1% to 9.7%.ConclusionsThe use of automated reception and TAT management system was associated with a decrease of overall TAT and an improved workflow at the phlebotomy room.

Abstract IA24: Building capacity and testing the impact of methods and variables for enhancing biospecimen donations with diverse communities

Abstract IA24: Building capacity and testing the impact of methods and variables for enhancing biospecimen donations with diverse communities

Jugular venipuncture and other innovative approaches to phlebotomy among people who inject drugs.

In their recent paper on patient experiences of accessing phlebotomy services in hospital outpatient clinics, Clements and colleagues state that there is a real need to better understand the responses of people who inject drugs to phlebotomy. They discuss the reasons why people who inject drugs might not be accessing healthcare services, especially in relation to treatment for hepatitis C. Their research is a welcome addition to the literature that emphasizes the stigma and discrimination faced by people who inject drugs, including within healthcare settings, and outlines the need to promote effective partnerships between healthcare workers and patients so as to deliver the best health outcomes.

Quantifying patient bacterial exposure risk from reusable phlebotomy tourniquets in a New Zealand secondary level hospital.

This study aimed to assess for the presence of multi-drug resistant organisms (MDROs) on tourniquets and quantify the number of bacteria to which patients might be exposed with each blood collection episode. Tourniquets were randomly sampled in a 246-bed, secondary level, New Zealand hospital, which is currently non-endemic for MDROs. A 6-cm length of each tourniquet sampled was applied to the surface of an agar plate and the colony forming units (CFUs) were enumerated. All colonies were then screened for MDROs using standard methods. CFU counts per linear centimetre were multiplied by a range of patient arm circumference measurements. Comparison was also made between non-disinfected tourniquets left on the wards and phlebotomy service tourniquets after daily decontamination with a proprietary disinfectant. The median exposure risk from non-disinfected tourniquets was 173 CFUs per collect (95% CI, 104-861). None of the general ward tourniquets grew any MDROs but four out of five dedicated, single-patient reusable isolation room tourniquets grew MRSA. Disinfected tourniquets had few if any CFUs and CFU counts were significantly lower than non-disinfected tourniquets (P = 0.0001). The quantitative risk from reusable tourniquets appears low in the setting of MDRO non-endemicity, with the application of standard infection control practices.

G550(P) Assessing communication in phlebotomy services in an in-patient setting

<h3>Abstract</h3> HIV-1 remains an incurable infection that is associated with substantial economic and epidemiologic impacts. HIV-associated neurocognitive disorders (HAND) are commonly linked with HIV-1 infection; despite the development of combination antiretroviral therapy (cART), HAND is still reported to affect at least 50% of HIV-1 infected individuals. It is believed that the over-amplification of inflammatory pathways, along with release of toxic viral proteins from infected cells, are primarily responsible for the neurological damage that is observed in HAND; however, the underlying mechanisms are not well-defined. Therefore, there is an unmet need to develop more physiologically relevant and reliable platforms for studying these pathologies. In recent years, neurospheres derived from induced pluripotent stem cells (iPSCs) have been utilized to model the effects of different neurotropic viruses. Here, we report the generation of neurospheres from iPSC-derived neural progenitor cells (NPCs). We show, for what we believed to be the first time, that these cultures are susceptible to retroviral (e.g. HIV-1, HTLV-1) infection. In addition, we also examine the functional effects of stem cell derived extracellular vesicles (EVs) on HIV-1 damaged cells as there is abundant literature supporting the reparative and regenerative properties of stem cell EVs in the context of various CNS pathologies. Consistent with the literature, our data suggests that stem cell EVs may modulate neuroprotective and anti-inflammatory properties in damaged cells. Collectively, this study demonstrates the feasibility of NPC-derived neurospheres for modeling HIV-1 infection and, subsequently, highlights the potential of stem cell EVs for rescuing cellular damage induced by HIV-1 infection.

Experiences of UK patients with hepatitis C virus infection accessing phlebotomy: A qualitative analysis.

This study provides an understanding of the experiences and perceptions of phlebotomy in people with infection who have venous damage related to injecting drug use with the aim of improving their care. Narrative interviews were conducted with 10 attendees of a phlebotomy service within an acute Trust in the south-west of England. The participants had hepatitis C infection and poor venous access due to current or former drug use. Interview audiotapes were analyzed, and the themes - conflict, emotional responses, the patient as expert, and offering solutions - were identified. In the context of this study, we discuss the difficulties associated with phlebotomy, which might explain why individuals with hepatitis C infection and venous damage disengage from health services and are less likely to undertake antiviral treatment. This research adds to the literature on phlebotomy for vulnerable groups, and recommends hepatitis C virus clinics within drug agencies, the need to review training and policy, and the development of "phlebotomy passports" to enable continuity of care between services.

Implementation of the systems approach to improve a pharmacist-managed vancomycin dosing service.

Quality improvements achieved by applying the systems approach to assess the clinical effectiveness, operational efficiency, and financial feasibility of a pharmacist-managed vancomycin dosing service are described. Faced with increased patient volumes and resource demands, the pharmacy department at Tufts Medical Center conducted an evaluation of its adult inpatient vancomycin dosing service using the systems approach, which emphasizes multidisciplinary assessment of system inputs, processes, and outcomes and consensus-building methods to identify needed changes and recommended action steps. A multidisciplinary committee composed of representatives of the medical center's pharmacy, internal medicine, infectious diseases, nursing, phlebotomy, and clinical laboratory services was assembled; in a series of three moderated monthly sessions, committee members deliberated and ultimately reached consensus on a list of action items. Relative to a concurrent intradepartmental assessment of the vancomycin dosing service based solely on pharmacist feedback, the systems approach identified a greater number and wider array of needed improvements in key program areas. Quality improvements implemented as a direct result of the systems-based analysis included a policy change authorizing pharmacists to order serum vancomycin determinations without physician cosignature and inclusion of a vancomycin dosing algorithm in the institutional antibiotic dosing guide. Future changes based on deliverable action items will result in a structured process to help direct program resources toward the patients most in need of pharmacist-managed vancomycin dosing services. The systems approach allowed for a comprehensive multidisciplinary evaluation of the service, as indicated by the identification of process improvements not identified by the department of pharmacy alone.

Improving the Efficiency of the Outpatient Phlebotomy Service at King Edward Memorial Hospital in Bermuda

Improving the Efficiency of the Outpatient Phlebotomy Service at King Edward Memorial Hospital in Bermuda

Customer satisfaction survey with clinical laboratory and phlebotomy services at a tertiary care unit level.

We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate our clinical laboratory and phlebotomy services. Thus, we wish to share our experiences with the customer satisfaction survey for clinical laboratory and phlebotomy services. Board members of our laboratory designed a study procedure and study population, and developed two types of questionnaire. A satisfaction survey for clinical laboratory services was conducted with 370 physicians and 125 nurses by using an online or paper questionnaire. The satisfaction survey for phlebotomy services was performed with 347 outpatients who received phlebotomy services by using computer-aided interviews. Mean satisfaction scores of physicians and nurses was 58.1, while outpatients' satisfaction score was 70.5. We identified several dissatisfactions with our clinical laboratory and phlebotomy services. First, physicians and nurses were most dissatisfied with the specimen collection and delivery process. Second, physicians and nurses were dissatisfied with phlebotomy services. Third, molecular genetic and cytogenetic tests were found more expensive than other tests. This study is significant in that it describes the first reference survey that offers a survey procedure and questionnaire to assess customer satisfaction with clinical laboratory and phlebotomy services at a tertiary care unit level.