Posted: May 1st, 2025

HIMA350 Week 6

CAS

E

OF THE BELATE

D

LAB

TEST

S

PROCE

SS

IMPROVEME

N

T OPPORTUNITY – PART

3

(sub parts A and B)

The Team went back to the data collection forms and created this data table of Phlebotomy turnaround times.

KEY:

TAT

– turnaround time

MF

– Monday through Friday

SS – Saturday and Sunday

D- Day

E – Evening

N – Night

TATTEST

MFD

MFD

3

.0

CBCMFE3B

SSE

.5LYTESSSD4B

MFD

CBCMFE3A

2.0LYTESMFD

4.5

CBCMFN3B

CBCSSD

CBCMFE4B

1.0BUNMFD3A

4.5LYTESMFE3B

2.0GLCMFE3B

4.5GLCSSN4A

4.5CBCMFD3A

LYTESMFD3A

2.0BUNMFD4B

GLCSSN4C

2.5CBCMFD3C

4.5GLCSSN4A

CBCSSE4C

LYTESMFN3A

5.0LYTESMFD3C

0.5CBCMFD4B

1.0LYTESMFD4C

LYTESMFE4A

1.5CBCSSE3C

1.0BUNMFN4C

4.0GLCMFD3A

2.0GLCSSD3C

3.0CBCMFD4B

2.5LYTESSSD3C

2.0GLCMFE4A

5.0CBCSSD3B

1.0CBCMFD4C

1.5LYTESMFE3C

4.5BUNMFN3B

2.0CBCMFD3C

4.0LYTESMFN4A

2.0LYTESMFE4B

3.5CBCMFD3A

2.5BUNMFD3C

1.5GLCMFN3A

4.5BUNSSN3B

1.5CBCMFD4C

3.0BUNSSD3A

2.0GLCMFE3C

4.0CBCMFN3C

1.0LYTESMFN4B

2.0CBCSSD3C

5.0LYTESMFD4A

2.0GLCMFD3C

544.5GLCSSE4B

2.5GLCMFE4B

2.0LYTESSSD3A

5.0CBCMFN3B

2.5BUNMFD3C

1.5GLCMFN4C

2.0CBCMFD4A

4.5BUNMFD4C

0.5LYTESSSE3C

4.5CBCMFN4A

3.0CBCMFD3C

2.0GLCMFE3A

4.0GLCSSE3C

2.5LYTESMFD3C

3.5GLCMFD4C

4.5LYTESMFE4B

1.0CBCSSD4B

SPECIMEN	DAY	SHIFT	FLOOR
1	1	.	5																								CBC									3B
2														2.0																			LYTES												3A
	4
											4 .5										BUN												4B
54
6							1.0																	GLC									4A
7			3.5
8										4C
9
10							2.5																		3C
11	5.5
12
13
14
15
16
17						1.5
18
19					5.0
20
21
22				3.0
23			0.5
24
25
26
27					4.0
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70

Assignment 6-Part A:

Put this data into an Excel spreadsheet and create multiple graphs that will show the relationship between TAT and the other factors.HELPFUL HINTS: TAT should be your vertical side of the graph. You will want a graph with Test, Shift, Day and Floor data displayed on the horizontal side of your graph. You will create 4 separate graphs.You want the graphs to actually tell you something – they should show exactly where there are issues.The first graph is comparing the type of tests, so you need to separate the data out by Test. You should find an average TAT for each type of test and put that in a table and graph it and see if it gives you some good information. So up the side you would have TAT and across the bottom you would just have 4 bars – one for each type of test.Same thing for day of the week data. Average the TAT for MF and average the TAT for SS and put that into a table and graph it. So again the TAT will be up the side and then you will have two bars, just one for MF and one for SS. This way you can see if there is a difference in the TAT for these two. You will do the same with shift and floor.There is an example with pretend numbers available to you

1. Describe what your graphs are showing you.

After viewing the graphs the team decides they need more information about the night shift……..

Interview With the Night Phlebotomist

Preface:The team decided a visit to the night shift or a discussion with the night phlebotomist (Dave Stick) would help to find some answers. The Assistant Administrator (Lotta) volunteered to talk to Dave. The Quality Advisor (Tom) thought it would be a good idea to join her.

——–CURTAIN UP—————–

Lotta: We have a big problem with the turnaround time for urgent lab tests here at the hospital, and the Quality Council has put together a PI team to work on this. Since the lab is part of my organization, I’m the team leader. We’ve studied this problem and found that blood-drawing for urgents on the night shift takes too long. We set up this meeting with you today to find out what’s going on.

Dave: What’s the Quality Council?

Lotta: It’s the hospital management, and they’re really concerned about urgent test turnaround times. Can you tell us why phlebotomy takes so long at night?

Dave: (getting defensive) I don’t know. Why don’t you talk to the floor secretaries? I hear they’re always slow at night. It’s certainly not my fault!

Tom: Maybe we should explain things a little more. There’s something about the process of drawing urgent specimens at night that seems to take longer than on the other shifts. We think there may be something different about the process and maybe we could think of ways to improve it if we understood it a little better. You’re the expert, so we’re talking to you. Could you help us understand what you do?

Dave: (relaxing a little) Well, everything’s different around here at night. You should come and visit us some time. I’m the only phlebotomist on duty and I’m on the run all the time. There used to be two of us, but, then there was the last round of cut backs. I think we need more night staff! You should tell THAT to your Quality Council!

Tom: You might be right – we may end up hiring more staff, but we can’t decide that without knowing more about the problem. Tell us about drawing blood at night.

Dave: Well, there are two of us in the lab at night, myself and one tech. I draw all the bloods and help out with the testing when I can. The phones are mostly answered by the Tech. She takes the request for a blood test and records it on a log sheet, by the floor. If it’s a STAT request, I go right out.

Lotta: What about the Urgents?

Dave: Those get called in, too. But, I can’t go running for them all the time. When I go out for a STAT, I do any urgents in that unit as well. Then, near the end of my shift, I go around to all the floors and draw the rest of the urgents and the routines, too. Anyway, after I do the draws, I bring the specimens down to the lab and leave them with the techs. Have you talked with the night tech?

Tom: we can do that if we need to. But, let me make sure I understand what you’ve told us so far. You go right out when a STATs called in and while you’re in the unit you take care of any urgents that are there. When an urgent’s called in, you don’t go right out, but at the end of your shift, you make a sweep of the units and take care of both the urgents and routines. Do I have it right?

Dave: That’s it. We used to go out for the urgents just like the STATs before the last cuts. After that, with just me on nights, we couldn’t do that. I told my supervisor about that and he said it was OK, if that was the best we could do.

Lotta: Harry agreed with that? I wonder why I didn’t know.

Dave: No, not Harry – the guy before him. I think he left and went to Valley Hospital. Look, I’m serious. There are lots of things that are done a little differently on the night shift.

Tom: I’m sure you’re right! One more thing. What do you know that’s special about units 3B and4A?

Dave: Oh, those. That’s Diagnostic Med and Psych. They have very few requests at night, and just about zero STATs. I never make a special trip up there. I’m telling you, we just don’t have the time to run out for every test at night. Besides, if they really want the results in a hurry, they order them STAT. If that Quality Council wants special runs for everyone, they’ll just have to bite the bullet and hire more night staff.

Tom: Well, I think you’ve given us a pretty clear picture. We really appreciate your being so frank with us. I wonder if you’d be willing to join our project team. What do you think?

Dave: That would be great. Us night people don’t get a chance to be involved in lots of things that go on during the day.

Lotta: I realize that. We could move our meetings to the first thing in the morning. And, I’ll see to it that you’re paid for the time.

——-CURTAIN DOWN—————

Assignment 6-Part B:

Critique this interview. What was done well? What was not done so well?

Where is the team in the problem-solving process?

Submit your assignment as a Word document.

Performance Improvement Project: Part I
Team Fury
Team Fury
Problem Statement
The current process for
laboratory test turnaround
time (TAT) at College
Community Hospital (CCH) is
experiencing
significant
delays and inconsistencies.
These inefficiencies result in
prolonged waiting times for
test results, leading to
dissatisfaction
among
physicians, nursing staff, and
patients. Addressing these
delays is crucial for improving
overall
patient
care,
operational efficiency, and
staff morale.
Benchmark Time Standards
STAT: 2 hours
Urgent: 6 hours
Routine: 24 hours
Goal Statement (Aim Statement)
The Lab TAT Enhancement Team aims to
improve the turnaround time for laboratory
tests at CCH, ensuring that 95% of tests are
completed within the established hospital
standards: 2 hours for STAT tests, 6 hours
for Urgent tests, and 24 hours for Routine
tests. This goal is to be achieved by
December 31, 2024.
Team Members
1) Lotta Paper – Assistant Administrator
(Team Leader)
2) Tom Trotter – Transport Supervisor
(Quality Advisor)
3) Beth Harrast – Floor Secretary, 3A
4) Harry Hiteck – Day Supervisor, Lab
5) Sam Drawit – Day Phlebotomist
6) Steve Spinner – Evening Lab Tech
7) Cathy Filer – Health Information
Management
➢
➢
➢
➢
➢
Proposed Timeline
Project Start Date
July 1, 2024
Project
End Date
December
31, 2024
Communication Plan
➢ Weekly Team Meetings
➢ Monthly Updates
➢ Final Report
Lab TAT Enhancement Team
Benefits of the Project
Accelerated turnaround times will enable physicians to make
more timely and informed medical decisions, directly improving
patient outcomes.
Reducing delays and enhancing efficiency will alleviate
frustrations among medical and nursing staff, fostering a more
positive work environment.
Streamlined processes will optimize resource utilization,
eliminate unnecessary steps, and reduce operational costs.
Faster delivery of test results will reduce patient anxiety and
enhance the overall patient experience, bolstering the hospital’s
reputation.
Improved use of the
Electronic Health Record (EHR) system will facilitate better
tracking and management of lab processes, leading to sustained
improvements.
Action Plan
1. Process Mapping
2. Data Collection
3. Root Cause Analysis
4. Implement Improvements
5. Monitor and Adjust
The Case of the Belated Lab Tests
Part 1: Flowchart
Doctor/Nurse writes test request
Request slip stamped by floor secretary
STAT or Urgent
Test
Priority
Call to Lab for pickup
Routine
Place in floor outbox
Phlebotomist picks up
Patient not available
Phlebotomist checks with
floor secretary
Patient
Availability
Patient available
Phlebotomist collects specimen
Specimen placed in lab inbox
Lab performs test
Results placed in lab outbox
Messenger picks up results
Results delivered to floor
Entered into patient chart
Scanned into EHR at discharge
The flowchart depicts the current process for handling laboratory test requests at College
Community Hospital (CCH). The process begins with a doctor or nurse writing a test request,
which is then stamped with the patient’s information by the floor secretary. The test request is
categorized based on urgency (STAT, Urgent, or Routine). STAT and Urgent requests trigger a call
to the lab for immediate pickup, while Routine requests are placed in the floor outbox. The
phlebotomist picks up the test requests and checks for patient availability. If the patient is not
available, the phlebotomist coordinates with the floor secretary to locate the patient. Once the
specimen is collected, it is placed in the lab inbox where lab personnel process the test. The results
are then placed in the lab outbox, from where the messenger picks them up and delivers them back
to the floor. The floor secretary files the results with the patient chart and flags them for the doctor.
Finally, at patient discharge, the results are scanned into the Electronic Health Record (EHR)
system. This flowchart highlights key points in the process, allowing the team to identify potential
areas of delay and inefficiency.
Part 2
Urgency
Number of Tests > Total Tests
Standard
% of Total
Standard
STAT
Urgent
Routine
Total
77
334
178
589
13%
57%
30%
459
1042
2121
3622
> Cumulative
Total
%
13%
70%
100%
60%
120%
50%
100%
40%
80%
30%
60%
20%
40%
10%
20%
0%
% of cumulative
% of totalStandard
Lab Test TAT Data
0%
STAT
Urgent
Routine
Urgency
% of Total > Standard
Cumulative % of Total
The graph titled “Lab Test TAT Data” depicts the percentage of laboratory tests that exceeded the
standard turnaround time, categorized by urgency (STAT, Urgent, and Routine). The blue bars
represent the percentage of tests that did not meet the standard, while the orange line indicates the
cumulative percentage of total tests over the standard.
Upon analyzing the graph, it is evident that Urgent tests constitute the highest percentage (57%)
of tests exceeding the standard turnaround time. This category alone accounts for a significant
portion of the delays, contributing to 70% of the cumulative total when combined with STAT tests.
of
Routine tests, although less urgent, also present a notable percentage (30%) of delays, leading to
the full cumulative total of 100%. STAT tests, which are expected to have the quickest turnaround,
represent the smallest portion (13%) of delays.
The data suggests that the most critical area to address is the Urgent tests, as they are the primary
contributor to the turnaround time issues. The high percentage of delays in Urgent tests reveals
that there is a process that needs to be optimized in terms of the time taken to complete the tests.
The more mundane routine tests also offer a good chance to implement process enhancements as
they are less demanding than acute emergency procedures. The situation with delayed STAT tests
is slightly better – only 62.9% of cases show that this parameter is higher in comparison with the
total number of tests; probably, the lab successfully implements an effective mechanism for
handling urgent tests, but there are still some inefficiencies.
Additional Data Needed:
The team requires additional in-depth information to provide better suggestions and make workrelated changes. The current dataset is more static, which is why it does not allow the team to
identify specific bottlenecks and inefficiencies necessary for optimization.
It is also extremely helpful to have more granular time stamps for each step. This includes the time
the test was ordered, the time the sample was taken, the time the sample reached the laboratory,
the time the test was carried out and lastly, the time the results were obtained. With these details
gathered from classrooms, it becomes easier to identify areas that experience the most delays.
It would also be helpful to know how an organization’s staffing levels vary across shifts. Decoding
if a staffing deficit is a reason for delays can prove beneficial in terms of organizing resources.
Likewise, information on equipment utilization, their schedule for service, and any problem faced
by lab equipment in terms of breakage are useful in identifying technical factors that may have
contributed to delays in turnaround time.
Discussion with the Team:
During the team meeting, the key discussion should be what actual data you would require to do a
correct root cause analysis. The team should identify whether and where specific time stamps for
each stage of the process are obtainable and whether there are available databases of staffing and
equipment usage. To adjust expectations, it is now appropriate to compare the current performance
to the reality or industry average.
In addition, the team should get quantitative data regarding this centre either through an interview
or by administering a questionnaire to staff who carry out the lab test. Evaluating their insights and
concerns may offer insights that qualitative data might not offer in the context of an evaluation of
cognitive science. The above areas of concern need to be dealt with in detail so that the team can
formulate a complete strategy for solving the turnaround time problems and establish efficient
process improvement solutions.