Running Out of Time:
Improving STAT Lab Turnaround Times on L7
A RITE Project
Goal: To reduce STAT lab turnaround times on L7
Submitted by Jennifer Meaney, MS, BSN, RN-BC, PCM for L7 Orthopedics
With the goal of improving patient safety and quality of care on L7, a Realizing Improvement through Team Empowerment (RITE) group was convened to address the delay in STAT lab turnaround times, which effects safe patient care. Prolonged STAT lab turnaround times can lead to delays in treatment and poor clinical outcomes, such as longer lengths of stay and transfers to higher levels of care. This interprofessional team was assembled with key stakeholders from Nursing, Nursing Quality, Pre-Analytical Services, Clinical Lab, Transfusion Services, and Performance Improvement to address this patient safety concern.
The Pre-Analytical Services group receives numerous SAFE reports regarding delays in phlebotomy collection of STAT labs. The policy for STAT lab turnaround time (TAT) is 30 minutes from time of order to time of collection. A review of data showed the average TAT across SHC averaged 168 minutes in 2021, which can lead to delays in care and poor patient outcomes. For example, on one unit alone, waiting times for nurses and physicians was calculated to cost over $90,000 each year.
RITE Team Members
Jennifer Fralick, Administrative Director Anatomic Pathology & Clinical Laboratories; Project Sponsor
Christina Kong, MD, Professor of Pathology; Project Sponsor
Jennifer Meaney, L7 PCM
Sheridan Jones, Nursing Quality Management Coordinator
Sivly Ray, Quality Coordinator Clinical Lab
Emily Howard, Transfusion Safety Officer Transfusion Services
Georgiana Remollo-Santos, Manager Lab- Pre-Analytical Services
Manuel Moreno, Supervisor Lab- Pre-Analytical Services
Clarissa Pelly, Supervisor Lab- Pre-Analytical Services
Josephine Rosales, Education Coordinator Lab- Pre-Analytical Services
Ryan Darke, Principal Improvement Professional Improvement Team; Project Coach
The RITE team used the A3 problem-solving process to help reduce STAT turnaround times. Unit L7 was the nursing unit represented on the team, and therefore work focused on this unit. The average TAT at the start of the project on L7 was 90.2 minutes and only 65% of STAT labs made the 30-minute timeline. After reviewing SAFEs and conducting Gemba rounds, the two top areas of concern were in communication between Nursing and Phlebotomy, as well as with incorrect documentation in Epic.
Huddles were held on L7 with the Pre-Analytical Services team and nursing to help explain the importance of the project and interventions. The first intervention was a small yellow sign placed on computer monitors in patient rooms as well as at nursing stations. These signs helped remind the nursing team to make sure status of lab collection (unit vs. lab-collect) were properly documented in Epic. This helped ensure Phlebotomy was able to see the order for collection.
The second intervention focused on the enhanced use of technology to improve communication between Nursing and Phlebotomy. A new change in workflow was implemented using Voalte: after morning rounds, a phlebotomist logged in and assigned themselves to L7. This helped the L7 nursing team directly communicate needs, delays, or changes in lab orders quickly. Nurses no longer needed to call the Laboratory Dispatch as the first line of communication. Both Nursing and Phlebotomy provided positive feedback on this enhancement in communication practice, specifically the improved efficiency between the two departments.
The final intervention was to develop an escalation pathway. With a tight 30-minute timeframe, Nursing needed to know who to contact if there was not a timely response. This pathway highlighted the availability of the Lab Dispatcher, Lab Lead, and Lab Supervisor via Voalte.
Positive feedback on this new workflow included:
The Successful Outcome
The result of these interventions was an improvement to 100% achievement in 30-minute STAT lab in February 2022. Remarkably, the TAT decreased from 90.2 minutes to 13.2 minutes in the same period. This was far beyond the expectation of the RITE Team.
Upon hearing the success of this project, Units F1 and EGR asked to participate. The RITE Team met with these units and developed a plan to implement these interventions as well. The Team is also working to include the escalation pathway in both Nursing and Phlebotomy policies, as well as developing an OPL to further disseminate Phlebotomy logging into units.
Amazing work! Thank you to the RITE team for your hard work on this impactful improvement project that improves patient safety.
"Effective! Nurses can call you directly."
"I believe it helps create a better workflow and an efficient way of communicating with nurses."
"I love that phlebotomy is on Voalte!"
"I texted Phlebotomy and they came right away. Amazing for communication!"