Changing routine inpatient blood draws to occur at midnight, rather than in the early morning, balances laboratory workload and improves the availability of test results, according to a study published in the June issue of the American Journal of Clinical Pathology. From a laboratory perspective, the researchers say that redesigning inflow of laboratory orders improves laboratory processing efficiency and cuts stat orders. Turnaround times and ordering practices were compared during an intervention period from Nov. 16 to 30, 2011, in which the researchers changed the timing of routine blood draws from the standard practice of early morning (6 a.m.) to midnight on five inpatient wards (160 bed capacity) to usual care during an observation period the prior weeks (Nov. 1 to 15, 2011). Previous evidence has shown that delayed reporting of early morning test results can lead to duplicate test orders and increases in the number of STAT orders. Additionally, it is documented from a workflow perspective that routine morning blood draws create an uneven workload distribution for the laboratory. The researchers found that altering the blood draw time changed the total volume of laboratory test orders from 4 a.m. to 8 a.m. for the entire institution from 55 percent […]
Changing routine inpatient blood draws to occur at midnight, rather than in the early morning, balances laboratory workload and improves the availability of test results, according to a study published in the June issue of the American Journal of Clinical Pathology. From a laboratory perspective, the researchers say that redesigning inflow of laboratory orders improves laboratory processing efficiency and cuts stat orders.
Turnaround times and ordering practices were compared during an intervention period from Nov. 16 to 30, 2011, in which the researchers changed the timing of routine blood draws from the standard practice of early morning (6 a.m.) to midnight on five inpatient wards (160 bed capacity) to usual care during an observation period the prior weeks (Nov. 1 to 15, 2011). Previous evidence has shown that delayed reporting of early morning test results can lead to duplicate test orders and increases in the number of STAT orders. Additionally, it is documented from a workflow perspective that routine morning blood draws create an uneven workload distribution for the laboratory.
The researchers found that altering the blood draw time changed the total volume of laboratory test orders from 4 a.m. to 8 a.m. for the entire institution from 55 percent to 39 percent, while total volumes increased from 12 percent to 30 percent from midnight to 4 a.m. Over the intervention period, STAT orders per day also decreased significantly (344 to 301). During the second week of the intervention (Nov. 22 to 30 following a process improvement in labeling that was implemented), morning blood specimen turnaround time decreased by 41.5 minutes compared with the observation period, which also cut delivery time by 27.2 minutes and processing time by 13.5 minutes. Similar cuts in total turnaround time and delivery time were seen for midnight specimens (decreases of 155.1 minutes and 169.8 minutes, respectively) following the labeling improvements.
“Some physicians may feel that midnight blood test results are too old and order repeat tests in the morning. Our results, however, did not show any evidence of additional laboratory ordering,” write the authors, led by Atsushi Sorita, M.D., then at Beth Israel Medical Center in New York. “A second unfounded concern,” they write, is that “abnormal test results may not be noticed in a timely manner if the ordering physician did not review them until the morning. Our hospital has overnight physician coverage and the laboratory reports highly abnormal values to the staff immediately.”
The authors conclude that this change in time of routine inpatient blood draws is both feasible and acceptable to patients and providers and may have “significant implications for hospital resource management.”
