Context Quality improvement project carried out on the general paediatrics ward involving the different medical teams, (general paediatrics, surgery, ENT, orthopaedics), the Nursing team and the phlebotomists
Problem We addressed the problem of the delay in the notification of failed blood tests from the phlebotomy team to the relevant medical team. This was identified to affect patient care by causing a delay in diagnosis, decisions about treatment and discharge, leading on to prolonging patient stay, this in affects the overall patient experience.
Assessment of problem and analysis of its causes The problem was quantified by assessing the total number of unsuccessful blood tests in 1 week and finding out how many of those had been communicated to the relevant medical team at the time. To understand how there could be possible breakdowns in communication, a day was spent with the phlebotomists to understand how they prioritise their jobs, how long they have per patient and what would be the best way for them to contact the medical team. The staff involved included junior doctors, phlebotomists and nurses.
Intervention At the end of each phlebotomy round, the phlebotomists bleep the nurse in charge for the ward and inform of any unsuccessful blood tests. The nurse in charge can then contact the relevant medical team so that they can act and decide whether the test is needed more urgently or can wait until the next phlebotomy round.
Strategy for change The change was implemented by being discussed at the weekly grand round session so that all staff were aware. Staff involved in the change included the medical team, nursing team and phlebotomists. The results were presented at an audit meeting and a re-audit was performed 1 year later showing a 100% success rate and that change had been sustained. These were results were then represented at junior doctor teaching and discussed in clinical governance breakfast meeting.
Measurement of improvement Pre intervention audit, 30 blood tests requested in 1 week, 11 unsuccessful, pre-intervention notification 27%There was a re-audit 2 weeks after intervention which showed 46 total blood requests in 1 week, 21 unsuccessful, post intervention notification 44% showing an improvement. A further re-audit done 1 year later showed 25 total blood tests requested in 1 week, 6 unsuccessful, 100% notification which confirmed sustained change in practice. The same methods were used in data collection as had been in the original data collection.
Effects of changes This change created a more effective way for phlebotomists to communicate with the relevant medical team through the nurse in charge which would not compromise their time to do their job. It also allowed the medical team to act in a timely manner in the knowledge of an unsuccessful blood tests to decide how to act. It improved working relations with the doctors and phlebotomists. This change completely resolved the problem which triggered our original work and has allowed us to try to seek further ways in which the service can be more efficient.
Lessons learnt This work has taught me the importance of learning first what process is in place before setting about to make changes. I feel this project was successful because we first looked at what the phlebotomists did in their role. We created process maps to understand how the current process was working. Next time I would consider involving other wards.
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