Phlebotomy in ED
Our ED physicians are requesting an increased in POC testing in the ED. However, looking at the data, TAT for Troponins in our ED once the specimen is received in the main lab to result averages 22 minutes! Looking at pre-analytic phase of testing, I discovered huge delays from time of order to collect, either the tech or nurse is unable to collect (difficult stick to workload issues) in a timely manner. Nurse protocols are put into place several years ago and this seem to improve the order to collect time.
we are exploring the option of a lean event between the lab and the ED but was wanting to hear from this very knowledgeable group if you experienced similar issues and what resolution did you come to. My fear is placing POC testing in the ED will not address the delays seen in collection but will increase organization cost. I am exploring the possibility of placing phlebotomists in the ED. Yes, I am a fix it fox which goes against all lean principles!!
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We have had phlebotomists in the ED for 20 hours a day for several years. It has helped tremendously with TAT, BUT the largest time delay is still in the collection and transfer of the sample to the lab.
We no longer have troponins in the ED, as the physicians would not use them correctly.
We also noticed that rather than dedicated POC tech(s), Those techs were being pulled to other duties and therefore the TAT was delayed and things were not as well controlled.
Good Luck!
Jean
We used to have Istat TNI's in the ED, and if I remember correctly the RN's didn't want to run them. It was one more thing that they had to do.
We have the floors drawing their own samples and then they get tubed to the lab. We use the mint green tops and spin for 3 minutes in a stat spin. This helps with the TAT, but the sample still has to get to the lab.
Tonya
About 15 years ago we created a POC lab in our ED's. It is staffed by about 40-45 EMT's, ED techs and phlebotomist. We did not add staff, we redesigned our staff duties. In our largest ED we perform over 5000 istat's per month (Chem 8, G3, BhCG, CG4 and Tropoinin) along with urine pregnancy testing and occult bloods. The lab was created to help with TAT and to decrease the number of staff trained for POC. We could not keep up with reagents or analyzers when they were scattered all across the dept. Having a dedicated space has been great, we have counter top space to work on (not a cart) phone to call critical values to providers, and small refrigerator space to store cartridges.
At times the problem still remains of getting the sample the POC lab because of large territory of the department. We usually have 2 phlebotomist (along with RN collects)on the unit collecting and 1 person in the POC lab running the tests. This is really important to be able to process i-stat samples in a timely manner, especially the lactic acid that can start to elevate after 15 minutes.
This process has worked well for us--we were able to use staff that was already in the department, decrease our POC user group, keep up with supplies, and have a focused group that is easy to educate on changes. It is much easier to keep up with education and train for new processes when you have a dedicated group. All staff work several times a month in the lab, a pleasant change to the other departments that show up for yearly recertification and say "I haven't done one of these since last year!"
Kim