Specimen Collection and Management

Specimen collection and management is essentially a human process that is managed by care providers in dynamic and often distracting environments. In this atmosphere of controlled chaos, it is no wonder that mistakes can be made that result in adverse patient events, including delayed and sometimes even inaccurate diagnosis. Missteps can bring myriad consequences, including negative reimbursements, patient injury, incomplete order fulfillment, duplication of efforts, and more seriously, misdiagnosis leading to potential loss of life. Hospitals simply cannot afford to make mistakes.

With so many potential hazards looming, it can be difficult for a hospital to know what type of specimen collection system would work best within the laboratory information system (LIS). A system that allows your organization to achieve zero errors is essential for the best patient care. But there are also other requirements. Ideally, the specimen collection system will also provide you with the following:

  • accountability/user identification–know who is handling specimens
  • automation–eliminate the potential for human error
  • safety–patient safety and satisfaction is a priority
  • simplicity–solutions should be easy to use
  • extensibility–the solution should effectively extend your LIS to every bedside in your enterprise, allowing technicians to automatically and immediately see any changes made to orders, which in turn improves workflow and potential for error reduction
  • regulatory compliance–your specimen collection system must meet the Joint Commission’s national patient safety goal (NSPG.01.01.01), stipulating use of at least two identifiers when providing care, treatment, and services.

Aside from these features, your specimen collection system should also help you achieve workflow excellence by gaining efficiencies wherever possible. In doing so, the system will enable you to drive down costs, improve physician and patient affinity, and increase revenue. In fact, a good specimen collection solution delivers significant productivity gains for phlebotomists as well as nursing staff. It should also have the capability to extend these benefits to other areas of the enterprise, for example, emergency departments.

Sunquest has conducted research on return on investment (ROI) for its specimen collection solution, based on real life examples at hospitals around the U.S. For example, Figure 1 summarizes the ROI on use of Collection Manager in the emergency department (ED) of a major hospital, where improvements significantly increased emergency department capacity by reducing turnaround time (TAT) for every result that pertained to the ED.

Decreasing TAT means that patients can be discharged an average of 10-15 minutes earlier. With an average of 40,000 patients per year, this adds about 200 days of capacity, with no increase in staff or beds.

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Taking all of those factors into account makes for a rather steep task for one specimen collection system. The two examples that follow show how the right specimen collection system can help solve many of the problems that facilities have today.

Florida Hospital

At Orlando’s Florida Hospital (FH), an 880-bed acute care hospital, 38 full-time phlebotomists draw and collect about 15,000 blood specimens per month, estimated at about 50% of all blood specimens collected at the hospital. The multi-step process used includes patient identification; specimen collection, labeling and transport; and data entry. Along the way, many of the steps include actions and processes that could lead to potential errors.

The hospital had conducted a Lean analysis of the specimen collection process, which indicated that approximately 50-60% of phlebotomists’ time was spent on a variety of non-productive activities, like walking from place to place and waiting for elevators. The hospital was looking for a specimen collection process that would automate the specimen collections and also improve patient safety and increase workflow efficiency. It selected Sunquest Collection Manager™ (CLM) in 2004, making it the foundation of its specimen collection management system (SCMS).

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Using the Lean principles the hospital established during its analysis, the new system moved from a batch specimen collection process to a just-in-time process, which removed variation and ensured accuracy. In addition, scanning patients with a barcode reader for positive patient identification and printing out labels right at the bedside has resulted in a noticeably increased level of confidence among patients.

Research indicated that the 50-60% of the phlebotomists’ time spent on traveling was reduced to 10-15%, and time per collection was reduced from 40 minutes to 15. In addition, before implementing its SCMS, only 40% of the FH stat samples were done within the lab’s established goal of 120 minutes after they are ordered. Now, more than 76% of the stat samples are done within this amount of time.

The reduced turnaround time had the added benefit of increasing the lab’s capacity to take in additional test volume. If even only a small percentage of this increased capacity is captured, it will result in significant additional revenue.

The FH lab has reduced its patient identification errors to less than one per year since the system began operation in 2004. This is a significantly better than other areas in the hospital not currently using the collection management system. In addition, the hospital finds that it is doing more with less staff because of the reduced amount of time each collection takes.

Lab personnel initially were reluctant to the workflow change, but user reaction is now extremely positive. The LIS team made some adjustments to the hand-held devices to make the functions extremely easy to use. They also added a few enhancements, like placing bar codes on phlebotomists’ name badges so they would not have to enter their user access codes at each collection.

ThedaCare

ThedaCare, based in Northeast Wisconsin, is one of the nation’s leading community-owned health systems. Numerous quality initiatives have helped it achieve recognition as a “top 100” healthcare organization with recognition from Solucient and HEDIS®-the Health Employer Data Information Set.

One of ThedaCare’s key technological initiatives in support of its enterprise patient safety goals has been the automation of its clinical laboratories, using Sunquest Collection Manager, along with other Sunquest Laboratory solutions and related modules from Sunquest Information Systems.

Implementing Collection Manager enabled ThedaCare to save approximately three full time equivalents (FTE) in the phlebotomy and central processing areas. This equates to more than $101,000 per year, calculated by using the weighted hourly costs of $21.70 per hour for a 30-hour work week at 52 weeks per year.

Automating Clinical Lab Operations

ThedaCare began the process of automating its clinical lab operations in the late 1980s, when physicians entered orders into the hospital information system (HIS), which were then printed in the laboratory and entered into the organization’s LIS, Sunquest Laboratory.

Labels were then printed for sample collection in batches, and the samples were collected by the phlebotomists. When the samples were received back at the laboratory, they were received into the LIS and technologists performed the testing. Some instruments were interfaced to the LIS to directly transfer results into the database, while others required manual data entry by the technologist.

Technologists monitored the test results for critical values, calling the physician and informing them of the results. In the case where a physician ordered additional tests on samples that had already been received by the lab, technologists located the samples manually. Reports were printed and then delivered by courier, mail, or faxed to physicians. The pathology lab sign-out process had multiple steps which included paper requisitions and culminated in a hand written signature on the final report.

To support the health system’s broader patient safety initiatives, ThedaCare re-centralized its specimen collection process in 2003. As part of that process, specimen collection, which was performed by care center staff, was reassigned to a centralized phlebotomy team in the laboratory.

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Though errors decreased, specimens mislabeled with another patient’s demographics still remained as a source of error in the phlebotomy process. To help make improvements, ThedaCare began using Sunquest Collection Manager.

Specimen Collection Workflow

The software addition enabled a substantial improvement in the lab’s workflow. Tests are still ordered through the healthcare organization’s information system, but the orders now move automatically through the Sunquest LIS and into Collection Manager. Orders are displayed on handheld devices and the phlebotomist achieves positive patient identification by scanning his or her own ID badge and the patient’s barcoded armband.

A portable printer prints each collection label at the patient’s bedside. A label is printed only for the current patient and the specific samples for that time of collection, eliminating the problem of mixing up labels from multiple patients and different collection times.

Collection Manager allows real-time transmission of all lab orders including stats directly to the phlebotomists’ handheld device, eliminating the need for dedicated laboratory call center personnel to dispatch the phlebotomist to collect the stat specimens. This reduces specimen collection time, resulting in faster delivery of the results to the doctors and a corresponding acceleration of patient treatment.

Following collection, the phlebotomist verifies the time and date of collection on their handheld device and sends all of the documentation for the collection back to Sunquest Lab via the wireless network. The sample is thus automatically received into the LIS, eliminating the need for manual receipt when the sample arrives in the lab.

The Sunquest Laboratory Information system autoverifies patient results by user-defined algorithms that verify that the results are within specified limits. This eliminates the need for user defined “normal” results to be reviewed by a technologist.

“The reporting of lab results has been converted from a manual process to one that is nearly fully automated,” says Jo Ann Lang, director of Lab, Outpatient and Guest Services. “Lab results are now automatically entered into the patient’s electronic medical record, and a link to the record is automatically sent to hospital physicians that have an account on that system. For the 30% of the lab’s business that comes from physicians that don’t have an account on the electronic medical record system, test results are sent to these physicians through an automated fax system. Paper reports need to be printed out only for a very small number of physicians.”

Productivity Gains

The examples cited show that proper specimen collection solutions enable the lab to operate at ultimate efficiency levels, and provide the community with the highest level of patient care. It also ensures that the hospital will meet national patient safety goals. Achieving the most efficient workflow is challenging, but selecting a good collection management solution allows hospital laboratories to function like a service line, enabling expanded revenue generation opportunities for the organization. Aside from improving the laboratory, the specimen collection solution has the potential to extend benefits to many other areas of the enterprise, most notably the emergency department.

Kelly Feist is vice president of Marketing at Sunquest Information Systems Inc.®

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