SkyRidge Medical Center Transition Presentation

Emergency Center

Surgical Services

ICU / Surgical Suites

Emergency CenterSpecimen Quality

Extended TAT

Mislabeled Specimens≥ 1 / month

Contaminated Blood Cultures

Improper collection technique

Delayed specimen transportation

Sample-related specimen rejection

Accounts for 46% of specimen rejections

Improper specimen labeling

Not labeled at the time of collection in the presence of the patient

Advanced PCT TrainingProvided by Laboratory

Initial Training:8 hours for PCT

4 hours for Nurse

< 80 hours over 2-3 pay periods

Continuous ReinforcementPeriodic education at staff meetings as needed

Improved Labeling Lab collection labels

Admission labelsPrint two sheets automatically when registered

Print manually

HandwrittenBlank labels / Sharpie

Tube SystemTransportation of specimens as collected rather than in batches

Transportation of “add-on” lab requisitions

Improved specimen qualityImproved specimen rejection ratesDecreased contamination ratesImproved interdepartmental teamwork

Time from order to receiptTime from collection to receiptResponse time for laboratory collections

Blood CulturesBlood Bank

Centralized slot boardOrganization of collection labels

Organization of reports

Visual organization of workflow

Laboratory AssistancePhlebotomy area in third Triage

Staffed from 1pm – 9pm Monday thru FridayAssistance with Blood Bank and Blood CulturesAssistance with EKG’s

Note: Promed “blue screen” required for Triage order entry

Blood Culture TeamworkEC staff draws 1st set with initial blood work

No line/I.V. draws (unless specified by physician)

Training provided by lab

Laboratory draws 2nd set

Improved TATSpecimen collection

Lab reports

Improved Blood Culture process

TAT for 1st set

TAT for initial blood work

Core measures Less delay in starting antibiotics

Surgical ServicesPre-operative process

Blood Bank armbands

Blood Bank armband (from pre-admission testing) required

Delay in Blood Bank response time

Distance (increased)Staff unavailable or involved in critical case

Delay in surgery schedule

Transportation of Blood Bank armband thru tube systemPatient armband applied by outpatient lab personnel

Patient identifiers cross-checked

Includes Blood Bank ID card presented by patient

Training provided by Blood Bank

Less delays in pre-operative processImproved time management for Blood Bank personnelImproved interdepartmental teamwork

ICU / Surgical SuitesNurse Collections (Line Draws)

Poor staff utilizationRequirement for lab personnel to be present

Generally unnecessary

Slower laboratory critical response time

Requires increased laboratory staffing

Independent Nurse Collections

Admission labels or lab labels for specimensNo line draws on blood cultures without physician orderReference material provided for appropriate sample type, volume, etc.Samples transported to lab thru the tube system

Improved TAT for ICU reports

Improved medical staff satisfaction

Improved time management for laboratory personnel

Improved interdepartmental teamwork

Misty Prock, M.T. (ASCP) - Presenter

Amy Pickelsimer, M.T. (AMT)

Jerry Falls, M.T. (ASCP)

Sandi Butcher, M.T. (ASCP)

Betty Hudson, M.T. (ASCP)

Penni Miller, M.T. (ASCP)

Pam Barber, ASPT