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Abstract
Background Timely reporting of critical values is a National Patient Safety Goal. Critical values are reported by telephone call from pathology customer service with provider readback.
Objectives Decrease the time from specimen collection to acknowledgment of a CBC critical value from 167 minutes by 16% in the oncology inpatient unit.
Methods The IHI Model for improvement methodology was utilized (figure 1). A process map (figure 2) and fishbone diagram (figure 3) were used to help identify two areas of opportunity. Firstly, the telephone call to alert providers of critical values is disruptive; they are often aware of the result. Secondly, phlebotomist collect samples on the oncology inpatient unit and on another unit, then they deliver all specimens to the laboratory on a cart. A multidisciplinary team met regularly to perform frequent PDSA cycles. The PDSA cycles focused on sending samples via pneumatic tube and the creation of an extra column on the Epic Patient list that allows for direct acknowledgment of critical values by providers.
Results The time from specimen collection to acknowledgment of a CBC critical value decreased from median time of 167 minutes (25th, 75th percentiles 160, 177) in July 2021 to 140 minutes (25th, 75th percentiles 124, 150) by March 2022 in the oncology inpatient unit (figure 4). This reduction was driven by the improvement in the unit turnaround time when samples were sent via pneumatic tube. Unfortunately, an unintended consequence was less timely acknowledgment of critical value results (the percent acknowledged within 30 minutes decreased) since they are now being reported earlier, on the overnight shift with less staff (figure 5).
Key driver diagram
Process map
Fishbone diagram
Outcome measure run chart
Process measure run chart
Conclusions IHI methodology led to reduced time from CBC collection to acknowledgment of critical values. Next steps will focus on utilization of the Epic direct acknowledgment with night shift providers to increase the percent of critical values acknowledged within 30 minutes.