J Clin Outcomes Manage
Aligning availability of morning laboratory results with physician rounding patterns
Giella P, Hargett BE, Wood CV
This month we introduce a new series, “The Emory Initiatives,” which will report on the implementation and outcomes of quality improvement activities ongoing at Emory Healthcare in Atlanta. Emory Healthcare, the largest health care system in Georgia, has established more than 100 clinical performance improvement initiative teams to ensure patients are receiving the highest quality of care. William A. Bornstein, MD, PhD, Chief Quality Officer at Emory Healthcare, with responsibility for quality improvement and patient safety initiatives throughout the system, is the series editor. At Emory, Dr. Bornstein has spearheaded a range of quality initiatives in such areas as central venous catheter safety, sedation, intensive care, and correct-site surgery and is a leader of Emory’s electronic medical record initiative. He initiated and championed a medication safety program in Emory Hospitals that reduced the number of reported prescribing errors and won the 2002 Patient Safety and Quality Award for a health system from the Partnership for Health and Accountability. Dr. Bornstein has been a leader at the national level in quality and safety improvement initiatives and is an advisor to The Leapfrog Group, JCAHO, and the University HealthSystem Consortium. Dr. Bornstein’s commentary on this month’s report appears on page 583. Abstract Objective: To align availability of laboratory results with physician rounding patterns by redesigning the test ordering process, specimen collection schedule, and coordination of resources between nursing and phlebotomy staff. Design: The FOCUS-PDCA (Find, Organize, Clarify, Understand, Select and Plan-Do-Check-Act) methodology was used to achieve departmental goals. Setting and participants: Nursing and phlebotomy staff processing test orders at 2 large tertiary teaching hospitals. Measures: Percentage of tests available by physician rounding time. Secondary outcomes included compliance with routine ordering priority and distribution of workload and percentage of tests collected by target time. Results: By the end of the 6-month study period, 85% of test results were available to physicians for their morning rounds, up from a baseline of less than 50%. In addition, tests ordered with a priority collection status of routine had improved to 75% from a baseline of 19%. Conclusion: While standardized collection times designed around physician rounding patterns improved availability of morning lab results, enhanced communication between lab and nursing staff to achieve higher efficiency and better patient care became cornerstones of the project.
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