Lab Test Scenario

The Team collect data 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

SPECIMEN	TAT	TEST	DAY	SHIFT	FLOOR
1	1.5	CBC	MF	D	3B
2	2.0	LYTES	MF	D	3A
3	4.0	CBC	MF	E	3B
4	.5	BUN	SS	E	4B
5	4.5	LYTES	SS	D	4B
6	1.0	GLC	MF	D	4A
7	3.5	CBC	MF	E	3A
8	2.0	LYTES	MF	D	4C
9	4.5	CBC	MF	N	3B
10	2.5	CBC	SS	D	3C
11	5.5	CBC	MF	E	4B
12	1.0	BUN	MF	D	3A
13	4.5	LYTES	MF	E	3B
14	2.0	GLC	MF	E	3B
15	4.5	GLC	SS	N	4A
16	4.5	CBC	MF	D	3A
17	1.5	LYTES	MF	D	3A
18	2.0	BUN	MF	D	4B
19	5.0	GLC	SS	N	4C
20	2.5	CBC	MF	D	3C
21	4.5	GLC	SS	N	4A
22	3.0	CBC	SS	E	4C
23	0.5	LYTES	MF	N	3A
24	5.0	LYTES	MF	D	3C
25	0.5	CBC	MF	D	4B
26	1.0	LYTES	MF	D	4C
27	4.0	LYTES	MF	E	4A
28	1.5	CBC	SS	E	3C
29	1.0	BUN	MF	N	4C
30	4.0	GLC	MF	D	3A
31	2.0	GLC	SS	D	3C
32	3.0	CBC	MF	D	4B
33	2.5	LYTES	SS	D	3C
34	2.0	GLC	MF	E	4A
35	5.0	CBC	SS	D	3B
36	1.0	CBC	MF	D	4C
37	1.5	LYTES	MF	E	3C
38	4.5	BUN	MF	N	3B
39	2.0	CBC	MF	D	3C
40	4.0	LYTES	MF	N	4A
41	2.0	LYTES	MF	E	4B
42	3.5	CBC	MF	D	3A
43	2.5	BUN	MF	D	3C
44	1.5	GLC	MF	N	3A
45	4.5	BUN	SS	N	3B
46	1.5	CBC	MF	D	4C
47	3.0	BUN	SS	D	3A
48	2.0	GLC	MF	E	3C
49	4.0	CBC	MF	N	3C
50	1.0	LYTES	MF	N	4B

Step 1

Put this data into an Excel spreadsheet and create a graph, or multiple graphs that will show the relationship between TAT and the other factors.

HINT:  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.  It might be easiest to create 4 separate graphs.

Step 2

Develop a summary which describes that your graphs are showing you and theories that you have for the root cause.

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 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 and 4A?

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.  We 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—————

Step 3

Using the data that has been collected and the information from the interview. Determine next steps in the process. Create a Gantt Chart which displays the timeline and the next five steps in the performance improvement process.