Outpatient Phlebotomy Success and Reasons for Specimen Rejection

2002 ◽  
Vol 126 (4) ◽  
pp. 416-419 ◽  
Author(s):  
Jane C. Dale ◽  
David A. Novis
Keyword(s):  
The United States ◽  
Blood Collection ◽  
Success Rates ◽  
Missing Information ◽  
Improvement Program ◽  
Practice Characteristics ◽  
Clinical Laboratories ◽  
Specimen Collection ◽  
Patient Preparation ◽  
Test Ordering

Abstract Objectives.—To determine the rate with which blood collection is successful on the initial phlebotomy encounter, the rate with which laboratory personnel judge specimens unsuitable for analysis, and the practice characteristics associated with fewer unsuccessful collections and fewer rejected specimens. Design.—Clinical laboratories participating in the College of American Pathologists Q-Probes laboratory improvement program prospectively characterized the outcome of outpatient phlebotomies for 3 months or until 20 unsuccessful phlebotomy encounters occurred. By questionnaire, participants provided information about test ordering, patient preparation, and specimen collection. Setting and Participants.—Institutions in the United States (n = 202), Canada (n = 4), Australia (n = 3), and South Korea (n = 1). Main Outcome Measures.—Percentage of successful encounters and percentage of unsuitable specimens. Results.—Of 833289 encounters, 829723 were successful. Phlebotomies were unsuccessful because patients were not fasting as directed (32.2%), phlebotomy orders were missing information (22.5%), patients specimens were difficult to draw (13.0%), patients left the collection area before specimens were collected (11.8%), patients were improperly prepared for reasons other than fasting (6.3%), patients presented at the wrong time (3.1%), or for other reasons (11.8%). Only 2153 specimens (0.3%) were unsuitable; these samples were hemolyzed (18.1%), of insufficient quantity (16.0%), clotted (13.4%), lost or not received in the laboratory (11.5%), inadequately labeled (5.8%), at variance with previous or expected results (4.8%), or unacceptable for other reasons (31.1%). Facilities staffed by laboratory-administered phlebotomists reported higher success rates than facilities staffed by nonlaboratory-administered phlebotomists (P = .002). Conclusions.—Most outpatient phlebotomy encounters are successful and result in specimens suitable for laboratory analysis.

Specimen Collection Volumes for Laboratory Tests

2003 ◽  
Vol 127 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Jane C. Dale ◽  
Stephen G. Ruby
Keyword(s):  
Blood Cell ◽  
Laboratory Tests ◽  
Private Institutions ◽  
Routine Laboratory ◽  
Improvement Program ◽  
Public And Private ◽  
Cell Counts ◽  
Clinical Laboratories ◽  
Blood Cell Counts ◽  
Specimen Collection

Abstract Context.—Unnecessary tests, inefficient ordering practices, and collection of more blood than is required for testing contribute to iatrogenic anemia in hospitalized patients. Laboratories accredited by the College of American Pathologists are expected to review phlebotomy practices for specimen collection volumes periodically. Objective.—To report specimen collection, analytic, and discard volumes for routine laboratory tests and to identify practice variables associated with overcollection and blood wastage. Design.—Clinical laboratories participating in the College of American Pathologists Q-Probes laboratory improvement program recorded collection container size, laboratory-defined requested volume, manufacturer-defined analytic volume, and average discard volume for routine complete blood cell counts and electrolyte panels ordered for patients in intensive care units. Participants provided information about their specimen collection, processing, and analytic practices in a questionnaire. Setting and Participants.—A total of 140 public and private institutions. Main Outcome Measures.—Overcollections for routine collections and for situations in which a reduced volume of specimen is collected, and average discard volume per tube. Results.—Laboratories collected a median of 2.76 mL (or 8.5 times) more than their instrument's analytic volume for routine complete blood cell counts and 1.75 mL (or 12 times) more than their instrument's analytic volume for routine electrolyte panels. For clinical situations in which reduced collection volumes were necessary, overcollection for the same analytes was 0.5 mL (3 times) and 0.44 mL (4.2 times), respectively. The median discard volume was 2.8 mL/tube for complete blood cell counts and 2.0 mL/tube for electrolyte panels. Specimen collection container size was directly associated with overcollections and discard volumes. Instrument analytic volume was not a determinant of blood wastage. Conclusions.—Most laboratories can decrease collection volumes without compromising the ability of the laboratory to report a reliable and timely result. Use of smaller collection tubes can help reduce blood wastage.

Solitary Blood Cultures

2001 ◽  
Vol 125 (10) ◽  
pp. 1290-1294
Author(s):  
David A. Novis ◽  
Jane C. Dale ◽  
Ron B. Schifman ◽  
Stephen G. Ruby ◽  
Molly K. Walsh
Keyword(s):  
Blood Culture ◽  
The United States ◽  
Blood Cultures ◽  
Private Institutions ◽  
Improvement Program ◽  
Institutional Practices ◽  
Public And Private ◽  
Control Programs ◽  
Practice Characteristics ◽  
Hospital Practices

Abstract Objective.—To determine the frequency with which solitary blood culture samples were submitted to laboratories serving small hospitals and to ascertain whether certain hospital practices relating to the performance of blood cultures were associated with lower solitary blood culture rates (SBCRs). Design.—Participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data prospectively on the numbers of solitary blood culture sets from adult patients submitted to their laboratories and answered questions about their institutions' practice characteristics relating to the collection of blood culture specimens. Setting and Participants.—Three hundred thirty-three public and private institutions with a median occupied bed size of 57. Participants were located in the United States (n = 329), Canada (n = 3), and Australia (n = 1). Main Outcome Measure.—The solitary blood culture rate was defined as the number of instances in which only 1 blood culture venipuncture was performed on an individual patient during a 24-hour period divided by the total number of blood culture venipunctures that were performed during the study period. Results.—Participants submitted data on 132 778 adult patient blood culture sets. The SBCRs were 3.4% or less in the top-performing 10% of participating institutions (90th percentile and above), 12.7% in the midrange of participating institutions (50th percentile), and 42.5% or more in the bottom-performing 10% of participating institutions (10th percentile and below). In half the participating institutions, the SBCRs for inpatients were 8.3% or less and for outpatients, 22% or less. Solitary blood culture rates were lower for institutions in which phlebotomists rather than nonphlebotomists routinely collected blood culture specimens, in which internal policies required drawing at least 2 blood culture sets, in which hospital personnel contacted clinicians when their laboratories received requests for solitary blood culture sets, and in which quality control programs monitored SBCRs routinely. Conclusions.—Hospitals can achieve SBCRs under 5%. Those hospitals with particularly high SBCRs may lower their rates by altering certain institutional practices.

Morning Rounds Inpatient Test Availability

2000 ◽  
Vol 124 (4) ◽  
pp. 499-503 ◽  
Author(s):  
David A. Novis ◽  
Jane C. Dale
Keyword(s):  
The United States ◽  
Early Morning ◽  
Physician Satisfaction ◽  
Test Results ◽  
Improvement Program ◽  
Public And Private ◽  
Laboratory Service ◽  
Practice Characteristics ◽  
Laboratory Services ◽  
Laboratory Test Results

Abstract Objectives.—To determine the success with which laboratories were able to report morning test results on time, the laboratory practice characteristics associated with improved success, and the degree of satisfaction among clinicians with the timeliness of laboratory service. Design.—Hospital laboratories participating in the College of American Pathologist Q-Probes laboratory quality improvement program prospectively calculated the percentages of morning-run complete blood cell count (CBC) and electrolyte results that were reported on or before predetermined reporting deadlines, completed questionnaires concerning their departments' practice characteristics as they related to performing morning blood work, and distributed to physician utilizers of morning laboratory services questionnaires evaluating physician satisfaction with laboratory services. Setting and Participants.—A total of 367 public and private institutions located in the United States (355), Canada (5), Australia (2), and 1 each in the United Kingdom, Spain, Brazil, Korea, and Guam. Main Outcome Measure.—The percentages of morning-run CBC and electrolyte results reported on or before predetermined reporting deadlines. Results.—Participants submitted data on 40 256 CBC and 39 604 electrolyte specimens. In aggregate, a total of 88.9% of these tests (90.2% of CBCs and 87.6% of electrolytes) were reported on or before the reporting deadlines that the participating laboratories set for themselves. Half of the participants reported 94.6% of their CBC results and 95.5% of their electrolyte results on or before their self-imposed reporting deadlines. No specific demographic features or departmental practice characteristics were associated with higher or lower rates of institutional reporting compliance. Most physician utilizers of early-morning laboratory test results believed that the laboratory is sensitive to and meets the needs of clinicians for timely reporting of early-morning test results. Conclusions.—Most laboratories are capable of reporting 95% of their routine morning laboratory tests on time, and most physicians are satisfied with their laboratories' morning testing service.

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

scholarly journals Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John P. Skendelas ◽  
Victor S. Alemany ◽  
Vincent Au ◽  
Devika Rao ◽  
John McNelis ◽  
...  
Keyword(s):  
New York ◽  
Acute Appendicitis ◽  
Incidental Finding ◽  
Population Sample ◽  
Operative Therapy ◽  
Operative Management ◽  
The United States ◽  
Improvement Program ◽  
Common Procedure ◽  
Appendiceal Neoplasms

Abstract Background Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010–2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed. Results We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years. Conclusions Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.

Blood collection and transfusion in the United States in 2001

Transfusion ◽  
2007 ◽  
Vol 47 (3) ◽  
pp. 385-394 ◽  
Author(s):  
Marian T. Sullivan ◽  
Russell Cotten ◽  
Elizabeth J. Read ◽  
Edward L. Wallace
Keyword(s):  
United States ◽  
The United States ◽  
Blood Collection

scholarly journals Diagnostic Stewardship Effectively Reduces Healthcare-Onset Clostridioides difficile Infections and Concurrent Laxative Use

2020 ◽  
Vol 41 (S1) ◽  
pp. s189-s191
Author(s):  
Dipesh Solanky ◽  
Ian Drobish ◽  
Derek Juang ◽  
Scott Johns ◽  
Sanjay Mehta ◽  
...  
Keyword(s):  
Enteral Feeding ◽  
Demographic Data ◽  
Healthcare Facility ◽  
The United States ◽  
Nucleic Acid Amplification ◽  
Fiscal Year ◽  
Medication Cost ◽  
Laxative Use ◽  
Clostridioides Difficile ◽  
Test Ordering

Background:Clostridioides difficile infection (CDI) accounts for >500,000 community-, nursing-, and hospital-acquired infections (HAIs), as well as 15,000–30,000 deaths, and =$4.8 billion in the United States annually. C. difficile toxin B gene nucleic acid amplification testing (NAAT) cannot distinguish between active CDI and colonization, particularly in the setting of laxative use or enteral feeding. Lack of judicious testing can result in the incorrect diagnosis of CDI, unnecessary CDI treatment, increased costs, and falsely augmented HAI rates. Like many healthcare facilities, the VA San Diego Healthcare System (VASDHS) solely utilizes C. difficile NAAT for CDI diagnosis. The aim of this study was to implement and evaluate a facility-wide initiative at the VASDHS to reduce healthcare onset, healthcare facility associated CDI (HO-HCFA CDI), including the use of a test ordering algorithm. Methods: From fiscal year (FY) 2015–2018, various measures were implemented including a hand hygiene initiative, reduction in fluoroquinolone usage, prompt isolation of patients with CDI, thorough terminal cleaning of rooms, and, lastly, a test-ordering algorithm starting FY2018. A retrospective study was performed to assess VASDHS HO-HCFA CDI case incidence, risk factors for infection, laxative or enteral feeding use at the time of testing, and CDI treatment. Results: Patient demographic data, medical history, CDI history, laxative use, treatment, and cost of CDI treatment were reviewed. From 2015 to 2018, 127 cases of HO-HCFA CDI were identified. The total number of HO-HCFA CDI cases and medication cost for CDI treatment were dramatically reduced from 2017 to 2018 following implementation of the test-ordering algorithm (Table 1, Fig. 1). This trend corresponded to a significant reduction in median HO-HCFA CDI cases per month (P = .02), medication cost of CDI treatment (P = .02), and proton pump inhibitor (PPI) use at the time of testing (P = .01). The number of positive HO-HCFA CDI cases associated with laxative use or escalation at the time of CDI testing (accounting for those on chronic laxatives) also decreased across the study period—most dramatically from 2015 vs 2016 (20 vs 14) and 2017 vs 2018 (11 vs 4) (Table 1). Conclusions: At the VASDHS, diagnostic stewardship of C. difficile NAAT with the use of a test-ordering algorithm significantly reduced HO-HCFA CDI incidence and treatment cost. This trend also corresponded with significantly less PPI use at the time of testing and reduced detection of colonization among patients with laxative-induced diarrhea. Diagnostic stewardship may serve as an effective tool to correctly diagnose and treat HO-HCFA CDI, while significantly reducing treatment costs.Funding: NoneDisclosures: None

Volunteers: An Effective Medium for Delivering Therapeutic Lifestyle Interventions

2021 ◽  
pp. 089011712110625
Author(s):  
Lillian M. Kent ◽  
Paul M. Rankin ◽  
Darren P. Morton ◽  
Rebekah M. Rankin ◽  
Roger L. Greenlaw ◽  
...  
Keyword(s):  
United States ◽  
Chronic Disease ◽  
Lifestyle Modification ◽  
Density Lipoprotein ◽  
Blood Lipid ◽  
The United States ◽  
Analysis Of Covariance ◽  
Health Improvement ◽  
Improvement Program ◽  
Blood Lipid Profile

Purpose Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States. Design Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012. Setting Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012. Subjects Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years). Measures Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose. Analysis Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes. Results The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P < .001) and HDL (1.9%, P < .001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P < .001), DBP (1.1%, P < .001), TC (1.4%, P = .004), LDL (2.3%, P < .001), TG (4.0%, P = .006), and FPG (2.7%, P < .001). However, the effect size differences between the groups were minimal (Cohen’s d .1-.2). Conclusions Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease.

Abstract 388: Quality Improvement in the Outpatient Setting: Observations from the PINNACLE Registry® 2009 Q4-2013 Q1

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Katie Kehoe ◽  
Sherry Shultz ◽  
Fran Fiocchi ◽  
Qiong Li ◽  
Thomas Shields ◽  
...  
Keyword(s):  
South Carolina ◽  
Quality Improvement ◽  
Office Visit ◽  
The United States ◽  
Outpatient Setting ◽  
Quality Improvement Initiative ◽  
The South ◽  
Improvement Program ◽  
Heart Center ◽  
Over Time

Title: Quality Improvement in the Outpatient Setting: Observations from the PINNACLE Registry® 2009 Q4-2013 Q1 Authors: Katie Kehoe BSN, MS 1 ; Sherry Shultz RN, BSN, CIO 2 ; Fran Fiocchi MPH 1 ; Qiong Li PhD 1 ; Thomas Shields 1 ; Charlie Devlin MD FACC, FACP, FASNC 2 ; Nathan T Glusenkamp, MA 1 ; J. Brendan Mullen 1 ; Angelo Ponirakis, PhD 1 ; 1 American College of Cardiology, Washington, DC 2 South Carolina Heart Center, Columbia SC Background: The PINNACLE Registry® at the American College of Cardiology is the first outpatient practice-based quality improvement program in the United States. Begun as a pilot program in 2007, the registry systematically collects and reports on adherence to clinical guidelines in the care of patients with coronary artery disease, hypertension, atrial fibrillation and heart failure. Over time, these reports offer a unique opportunity for Quality Improvement (QI) in the outpatient setting. The current study aimed to assess the effect of QI in the outpatient setting using PINNACLE Registry data. Methods: The South Carolina Heart Center is a cardiovascular practice in Columbia, South Carolina. There are 19 providers, 5 office locations and NextGen EMR. The practice’s Quality Committee and Board meet monthly to review PINNACLE reports and identify areas for QI. This Clinical Quality Improvement Initiative began 10 years ago and consists of physicians, nurses, administrators, medical assistants, a medical record analyst and information systems staff. During this review, providers’ data was not blinded to others. QI Interventions implemented included physician and staff education, improving documentation during the office visit, addition of necessary fields to capture missing data and routine planned internal audits. Between October 1, 2009 and March 31, 2013 a total of 161,873 patient encounters were submitted to the registry. A two-tailed z test was performed to assess the significance in percentage changes between 2009 to 2013. Results: The following table showed significant percentage changes in six performance measures indicating interventions implemented by the practice demonstrate significant quality improvement over time from 2009-2013. Conclusions: Utilizing their PINNACLE Registry reports, the South Carolina Heart Center identified several areas for QI. Implementing multiple interventions, this practice was able to significantly improve their PINNACLE Reports and the quality of care provided.

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