LQPB2502 - CMLE - A Quality Improvement Project to Improve Phlebotomy Outcomes in a Clinical Setting-A Quality Improvement Project to Improve Phlebotomy Outcomes in a Clinical Setting

A Quality Improvement Project to Improve Phlebotomy Outcomes in a Clinical Setting

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This document presents a comprehensive overview of a quality improvement (QI) initiative aimed at reducing pre-analytical errors in blood specimen collection, focusing on phlebotomy processes at an urban academic medical center. Pre-analytical errors—occurring before laboratory testing, during specimen ordering, collection, handling, and transport—constitute 60-70% of laboratory specimen rejections and significantly impact patient care by delaying diagnosis, increasing costs, and lowering patient satisfaction.<br /><br />An audit performed over six months identified the emergency department (ED) as having the highest specimen rejection rate (31%), with the most common cause being use of the wrong blood collection tube. Four main categories of specimen rejection were outlined: specimen collection errors (wrong tube, insufficient volume), specimen quality issues (hemolysis, clotting), specimen labeling mistakes, and specimen ordering errors (inappropriate tests).<br /><br />In response, the QI team collaborated with ED leadership and other stakeholders to implement an educational intervention involving comprehensive phlebotomy carts. These mobile carts contained all necessary supplies, arranged by test type and accompanied by clear visual guides detailing tube types, test requirements, the correct order of draw, and technique tips. This resource addressed staff requests for a standardized, accessible reference.<br /><br />Post-implementation audit data showed a 20% reduction in specimen rejections in the ED, surpassing the initial 10% reduction goal. The case underscores the critical role of continual quality monitoring, education, and standardized processes to enhance specimen collection accuracy and patient outcomes. It also differentiates quality control (QC), assurance (QA), and improvement (QI), highlighting QI’s focus on data-driven process enhancements.<br /><br />Overall, this initiative demonstrates how targeted education and resource development can effectively reduce pre-analytical errors, improve lab result reliability, and promote patient safety and care efficiency in clinical settings.

Keywords

quality improvement

pre-analytical errors

blood specimen collection

phlebotomy

emergency department

specimen rejection

educational intervention

phlebotomy carts

laboratory specimen handling

patient safety