Background: Obtaining blood work through venipuncture is an important part of the diagnosis and management of hospitalized patients. Through formal and informal patient complaints, we found that patients admitted to the University of Colorado Hospital (UCH) report an excessive number of venipunctures for laboratory blood sampling. This results in overuse of resources, excess patient discomfort, and contributes to iatrogenic blood loss. More specifically, the estimated cost for each venipuncture is $101and takes approximately 10 minutes of health technicians’ time to collect each sample.
Purpose: To improve value through decreasing the number of venipunctures performed on hospitalized adult patients at UCH.
Description: A resident led team of physicians, students, and laboratory personnel designed a Quality Improvement Project to decrease excessive venipunctures on hospitalized adult patients at UCH. A needs assessment was performed which included: 1) Review of patient safety events reported through a confidential hospital-wide reporting system, 2) Interviews with patients and providers regarding what they deemed as an “acceptable” number of venipunctures per day, 3) Data analysis to determine the total number of venipunctures per patient per day, and 4) A root cause analysis highlighting the current process lab order and draw process, factors contributing to excess venipunctures, and areas for intervention. Our analysis included data from hospitalized, floor (non-ICU) patients from January to September of 2017 at a single academic medical center.
Conclusions: Through patient and provider surveys, we found the average acceptable number of daily venipunctures was three. During our study period, we found 3077 patient days where patients received more than three venipunctures. Further, there were 47 patient days where patient received more than seven venipunctures – equating to a venipuncture once every three hours, or more. One major contributor to this large number of venipunctures is failed add-on labs. Failed add-on labs are venipunctures that happen when providers attempt to “add-on” a test to a blood specimen already in the lab. When this fails (IE the lab is not performed), the UCH lab automatically generates an order for a new venipuncture, without provider notification. Through our analysis, we found that over 3400 venipunctures were generated in this fashion. We then further determined that over 700 of these venipunctures were for labs determined to be “non-urgent,” labs whose results have no immediate impact on patient care. We estimate by simply eliminating venipunctures that result from “non-urgent” “failed” add-on labs, over 700 venipunctures could be saved. This equates to an estimated savings of $70,000 and approximately 5.3 days of health technician time. This project highlights that significant value can be gained through focusing on process improvement interventions.