Delay | Reason | Work around | Intervention required |
---|---|---|---|
4 hours delay to making the request. | Not enough time to complete blood forms on the ward round, so forms completed after the 4-hour ward round. | Junior doctor leaves ward round to complete form (and take blood) missing vital decisions regarding patient care. The alternative is to request tests the day before – many of which may not be correct or necessary on the following day. | Forms available on the trolley and completed by any doctor on the ward round (including the consultant when necessary). Forms dated with the required date of the test. |
24 hours delay to blood taken. | The phlebotomists’ rounds happened while the ward round happened. So, any blood test requests made after the ward round were taken 24 hours later. | Doctor taking blood takes 12 minutes: 10 minutes to find the kit and gloves with many interruptions. So, doctor asks phlebotomists to take ‘urgent’ samples. | Phlebotomists start at 7.30am rather than 8.00am to get the samples to the lab. Every bay on every ward has a fully stocked trolley for taking blood and putting up drips. |
1.5 hours delay to transport. | The phlebotomists (and other clinical staff) left specimens in the ward out-tray for the porters rounds which occurred every 1.5 hours. | Doctors and nurses phone the porters to take urgent samples to the lab. Porters prioritise these calls. | Between 7.30 to 9.00am two porters ‘chase’ the six phlebotomists from ward to lab and back to next ward so that smaller batches are delivered continuously to the lab. |
20 minutes delay to processing. | Big batches of work arriving in the lab to be registered. | Lab technicians prioritise ‘urgent’ samples from A&E over ward, OP and GP samples. | Six technicians continuously register samples from all sources as they arrive. |
Half hour delay to verification and release. | Lab scientist looks at the results every half hour before releasing a batch electronically onto the clinical info system. | Lab staff stop work to search for ‘urgent’ requests and results. | One lab scientist continuously reads, verifies and releases results from 8.00am to 12.00pm. |
12 hours delay to action. | Results released in the afternoon are acted on the next morning. | Night staff and out-of-hours GP called urgently to deal with unexpected and dangerously abnormal results for patients they don’t know. | All samples and results cleared and released by 4.00pm so requesting doctors can act on the result. |
A&E = accident and emergency; GP = general practitioner; OP = outpatient