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Reducing the number of clinical stat phlebotomy orders: feasible or not?

  • Jolanda Scherrenburg , Dennis J. van de Wijngaart and Pim M.W. Janssens EMAIL logo
Published/Copyright: June 29, 2012
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 50 Issue 12

Abstract

Background: To manage the costs and performance of diagnostic services involving laboratory testing permanent evaluation is required. Among these, the ever increasing use of stat ordering, involving labour intensive phlebotomy, warrants explanation, especially for a phlebotomy service organised by the laboratory, not by those responsible for and/or carrying out the requests, such as doctors and nurses.

Methods: To explore the possibilities to reduce the number of stat phlebotomy requests, we conducted a survey among nurses and doctors of their motives in requesting 109 randomly selected stat orders.

Results: Fifty-five percent of all stat phlebotomy orders were requested for immediate decision-making with respect to urgently required diagnosis and patient care, defined by us as medical reasons. The other 45% of the stat orders were made for logistical reasons relating to the patient care or the hospital organisation. In total, 19 phlebotomy requests (17%) were unnecessary and could have been avoided. For most of the stat phlebotomy orders alternatives were not possible, as only 2% of the requests could have been replaced by analysis in material that had been withdrawn earlier.

Conclusions: The majority of the stat orders for phlebotomy were requested for good reasons, about equally distributed among the medical and logistical needs. This sets limits to the measures being feasible to further improve stat phlebotomy ordering efficiency, taking into account the way of functioning of modern hospital care.

Keywords: blood sampling; cost reduction; laboratory management; ordering behaviour; phlebotomy; stat orders
Corresponding author: Pim M.W. Janssens, PhD, Laboratory of Clinical Chemistry and Haematology, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands

We would like to thank Allison Edwards for her support in editing our manuscript.

Conflict of interest statement

Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

References

1. Janssens PM. Managing the demand for laboratory testing: options and opportunities. Clin Chim Acta 2010;411:1596–602.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000282562200008&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar

2. Fleisher M, Schwartz MK. Strategies of organization and service for the critical-care laboratory. Clin Chem 1990;36:1557–61.10.1093/clinchem/36.8.1557Search in Google Scholar

3. Anonymous. Should non-phlebotomists be allowed to draw blood? Clin Leadersh Manag Rev 2001;15:426–8.Search in Google Scholar

4. Jones BA, Walsh MK, Ruby SG. Hospital nursing satisfaction with clinical laboratory services: a College of American Pathologists Q-Probes study of 162 institutions. Arch Pathol Lab Med 2006;130:1756–61.10.5858/2006-130-1756-HNSWCLSearch in Google Scholar PubMed

5. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Phlebotomy issues and quality improvement in results of laboratory testing. Clin Lab 2006;52:217–30.Search in Google Scholar

6. Fidler JR. Task analysis revisited: refining the phlebotomy technician scope of practice and assessing longitudinal change in competencies. Eval Health Prof 2007;30:150–69.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000246447000004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1177/0163278707300631Search in Google Scholar PubMed

7. Blau G, Chapman S, Doyle K, Freeman V, Holladay B. Task scales performed and testing for scale differences among phlebotomy technicians, medical laboratory technicians, and medical technologists. J Allied Health 2007;36:150–6.Search in Google Scholar

8. Dobson R. NHS attracts German doctors. Br Med J 2004; 328:604.10.1136/bmj.328.7440.604-gSearch in Google Scholar

9. Steindel SJ, Novis DA. Using outlier events to monitor test turnaround time. Arch Pathol Lab Med 1999;123: 607–14.10.5858/1999-123-0607-UOETMTSearch in Google Scholar PubMed

10. Smellie WS, Murphy MJ, Galloway PJ, Hinnie J, McIlroy J, Dryburgh FJ. Audit of an emergency biochemistry service. J Clin Pathol 1995;48:1126–9.10.1136/jcp.48.12.1126Search in Google Scholar PubMed PubMed Central

11. Soffiati G, Giavarina D. Stat laboratory testing: integration or autonomy? Clin Chem Lab Med 2010;48:927–30.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000279341900005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1515/CCLM.2010.187Search in Google Scholar

12. Warner JL. Recentralizing phlebotomy back into the laboratory. Clin Leadersh Manag Rev 2005;19:E3.Search in Google Scholar

13. Plebani M, Carraro P. Mistakes in a stat laboratory: types and frequency. Clin Chem 1997;43:1348–51.10.1093/clinchem/43.8.1348Search in Google Scholar

14. Bekeris LG, Tworek JA, Walsh MK, Valenstein PN. Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Arch Pathol Lab Med 2005;129:1222–5.10.5858/2005-129-1222-TIBCCASearch in Google Scholar PubMed

Received: 2012-05-06
Accepted: 2012-06-04
Published Online: 2012-06-29
Published in Print: 2012-12-01

©2012 by Walter de Gruyter Berlin Boston

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  4. Phlebotomy, stat testing and laboratory organization: an intriguing relationship
  5. Human epididymis protein 4: the start of a post-ROMAn era?
  6. Hyperhomocysteinemia in health and disease: where we are now, and where do we go from here?
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  9. The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure
  10. Biomarkers in primary open angle glaucoma
  11. Mini Review
  12. Identification of circulating microRNAs as biomarkers in cancers: what have we got?
  13. Opinion Paper
  14. HE4 in gynecological cancers: report of a European investigators and experts meeting
  15. Guidelines and Recommendations
  16. Position paper on laboratory testing for patients taking new oral anticoagulants. Consensus document of FCSA, SIMeL, SIBioC and CISMEL1)
  17. General Clinical Chemistry and Laboratory Medicine
  18. Reducing the number of clinical stat phlebotomy orders: feasible or not?
  19. Calculating acid-base and oxygenation status during COPD exacerbation using mathematically arterialised venous blood
  20. UrineCART, a machine learning method for establishment of review rules based on UF-1000i flow cytometry and dipstick or reflectance photometer
  21. Reference Values and Biological Variations
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  23. Cancer Diagnostics
  24. Identification of a novel in-frame deletion in BRCA2 and analysis of variants of BRCA1/2 in Italian patients affected with hereditary breast and ovarian cancer
  25. Human epididymis protein 4 (HE4) in benign and malignant diseases
  26. Human epididymis protein 4 as a serum marker for diagnosis of endometrial carcinoma and prediction of clinical outcome
  27. A predictive equation to adjust for clinical variables in soluble mesothelin-related protein (SMRP) levels
  28. Cardiovascular Diseases
  29. Vitamin D deficiency parallels inflammation and immune activation, the Ludwigshafen Risk and Cardiovascular Health (LURIC) study
  30. Plasma homocysteine and the risk of venous thromboembolism: insights from the FIELD study
  31. Letters to the Editor
  32. A two-base-pairs deletion in the albumin gene causes a new case of analbuminemia
  33. Usefulness of an antiglycolytic granular mixture of sodium fluoride and citrate for stabilizing plasma homocysteine levels
  34. Further insights on the relationship between bilirubin and C-reactive protein
  35. Phosphoethanolamine normal range in pediatric urines for hypophosphatasia screening
  36. Risk of false positive hepatitis C virus RNA due to sample to sample carryover on an automated hematology analyzer
  37. Lack of commutability between a quality control material and plasma samples in a troponin I measurement system
  38. Biological variation in pregnancy-associated plasma protein-A in healthy men and non-pregnant healthy women
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  40. Acknowledgment
  41. Acknowledgment
https://doi.org/10.1515/cclm-2012-0286
Keywords for this article
blood sampling; cost reduction; laboratory management; ordering behaviour; phlebotomy; stat orders

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Editorials
  4. Phlebotomy, stat testing and laboratory organization: an intriguing relationship
  5. Human epididymis protein 4: the start of a post-ROMAn era?
  6. Hyperhomocysteinemia in health and disease: where we are now, and where do we go from here?
  7. Reviews
  8. The usefulness of cystatin C and related formulae in pediatrics
  9. The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure
  10. Biomarkers in primary open angle glaucoma
  11. Mini Review
  12. Identification of circulating microRNAs as biomarkers in cancers: what have we got?
  13. Opinion Paper
  14. HE4 in gynecological cancers: report of a European investigators and experts meeting
  15. Guidelines and Recommendations
  16. Position paper on laboratory testing for patients taking new oral anticoagulants. Consensus document of FCSA, SIMeL, SIBioC and CISMEL1)
  17. General Clinical Chemistry and Laboratory Medicine
  18. Reducing the number of clinical stat phlebotomy orders: feasible or not?
  19. Calculating acid-base and oxygenation status during COPD exacerbation using mathematically arterialised venous blood
  20. UrineCART, a machine learning method for establishment of review rules based on UF-1000i flow cytometry and dipstick or reflectance photometer
  21. Reference Values and Biological Variations
  22. Assessing seasonality in clinical research
  23. Cancer Diagnostics
  24. Identification of a novel in-frame deletion in BRCA2 and analysis of variants of BRCA1/2 in Italian patients affected with hereditary breast and ovarian cancer
  25. Human epididymis protein 4 (HE4) in benign and malignant diseases
  26. Human epididymis protein 4 as a serum marker for diagnosis of endometrial carcinoma and prediction of clinical outcome
  27. A predictive equation to adjust for clinical variables in soluble mesothelin-related protein (SMRP) levels
  28. Cardiovascular Diseases
  29. Vitamin D deficiency parallels inflammation and immune activation, the Ludwigshafen Risk and Cardiovascular Health (LURIC) study
  30. Plasma homocysteine and the risk of venous thromboembolism: insights from the FIELD study
  31. Letters to the Editor
  32. A two-base-pairs deletion in the albumin gene causes a new case of analbuminemia
  33. Usefulness of an antiglycolytic granular mixture of sodium fluoride and citrate for stabilizing plasma homocysteine levels
  34. Further insights on the relationship between bilirubin and C-reactive protein
  35. Phosphoethanolamine normal range in pediatric urines for hypophosphatasia screening
  36. Risk of false positive hepatitis C virus RNA due to sample to sample carryover on an automated hematology analyzer
  37. Lack of commutability between a quality control material and plasma samples in a troponin I measurement system
  38. Biological variation in pregnancy-associated plasma protein-A in healthy men and non-pregnant healthy women
  39. Investigation of a slope discontinuity in a patients’ results distribution for D-dimer
  40. Acknowledgment
  41. Acknowledgment
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