Problems and solutions in phlebotomy patient flow

Why is it important ?

25% - 30% of outpatients (and the majority of inpatients) benefit from routine blood collection services every day. It is important to ensure the smooth flow of a large number of patients. During and after the Covid-19, more attention should be paid to this unit, where agglomerations can occur. According to the literature, 60% - 70% of the sample errors that occur during the laboratory testing phase occur during the blood collection phase. This is another indication of how important bloodletting is in terms of not delaying medical procedures.

Although institutions apply different methods, there is no "silver bullet" that can solve all problems by itself in blood collection units. Instead, all steps of the process and problems should be considered as interacting parts of a bigger system and the problem should be approached with a system view in mind.

The purpose of blood collection is to collect the patient's blood in accordance with medical standards in order to perform laboratory tests and to create a blood sample on which laboratory tests can be performed safely.

Blood collection workflow issues can be examined in two main groups for inpatients and outpatients. Our article will be more focused on outpatient work and patient flow.

There are various problems in phlebotomy patient flow.

• Failure to calculate costs at the patient subgroup level
• Inability to monitor personnel and center performance based on data
• Inability to measure, manage and optimize resource usage
• Unpredictability of required resources due to high variance in patient burden (eg: How many blood collection nurses are required?)

Another group of problems;

• Unpredictability of service quality due to high variance in patient waiting times
• Lack of computational tools to identify center quality indicators and provide a way to achieve these goals
• Failure to collect data on patient satisfaction, failure to monitor daily changes
• Patient and sample safety issues; identification errors, tube and labeling errors, failure to follow the standard blood collection order (eg: blood culture, tubes containing sodium citrate, serum tubes, tube containing heparin or without gel, etc.)

Other issues

• Lack of coordination between staff in the unit or between staff and patients, unbalanced load distribution among blood collection personnel, etc.
• Problems in determining or implementing patient priorities
• Not being able to record all the steps of the process
• Performance of patient flow is left to personal initiatives that can not be controlled effectively
• Lack of a motivation system based on data amongst the staff

The introduction of a large number of new tests, the Covid-19 process and the needs of patients after the pandemic indicate that the importance of blood collection services for the increasing elderly population will increase.

Süleyman Sevinç, Prof. Dr.

There are also problems to be solved in terms of patients and pandemic management.

• Uncomfortable and long waiting periods for patients
• Patients not knowing enough about the next step
• Loss of medical accuracy of test results due to failure to adhere to timing or follow-up/confirmation in repetitive steps of repetitive (challenge) tests (eg, rescheduling in OGTT test).
• The center does not have a clear strategy to identify and manage the current new risks posed by ongoing and future pandemics (eg, how can I reduce the risk of patient-patient and patient-staff infection at the center, how can I ensure social distancing?)

... there is no "silver bullet" that can solve all problems by itself in blood collection units. Instead, all steps of the process and problems should be considered as interacting parts of a bigger system and the problem should be approached with a system view in mind

Süleyman Sevinç, Prof. Dr.