Background: Literature on the timing of inpatient laboratory test collection is limited. Most studies suggest that physicians and patients are satisfied with morning collection [1], more specifically, intermittent late morning lab collection to decrease sleep disruption [2,3]. Evening labs put increasing demands on healthcare providers given limited resources available outside standard work hours. We sought to improve healthcare provider and patient satisfaction, while maintaining patient outcomes, through transitioning from an evening (2100) to morning (0500) lab collection process.

Methods: We conducted a quality improvement study across two inpatient general practice units (GPU), each with 20 beds, from June to August 2021. 0500 collection time was piloted on one unit (intervention) with the other unit (control) continuing routine 2100 collection time. A 30-question survey utilizing 5-point Likert scale format was provided to each healthcare provider (resident, nurse, and nurse assistant) at the beginning and end of each of the three rotation months encompassing the study. Results of patient satisfaction surveys were gathered from hospital administration. Patient outcomes were extracted from the hospital database. Responses to surveys were analyzed as continuous variables with t-test or Mann-Whitney U testing, and a p-value cutoff of <0.05 was used for statistical significance.

Results: A total of 66 residents (22 PGY3, 44 PGY1), 26 nurses and 5 nurse assistants were surveyed regarding workflow, satisfaction, and safety, with 18% of the surveys being obtained from the night shift. On the resident survey, the 0500 intervention floor had significantly higher satisfaction compared to the 2100 control GPU. While not significant, the residents that completed the survey on the 2100 control floor scored higher on negative survey statements such as “I would change the workflow of lab collection” and “patients’ overall medical care is impacted by the lab collection process”. Nurses on the 2100 control floor rated significantly higher on the survey statements such as, “I would change the lab workflow reporting” and “the lab collection process impacts physician ability to provide patient care”. When comparing the 0500 intervention floor prior to intervention (February-May 2021) to the intervention period (June-August 2021), we found that length of stay did not increase (4.5 days [pre-intervention], 4.5 days [intervention]), however, the percent of discharge orders placed prior to 10 am increased from 11.8% to 20%. Patients that stayed on the 0500 intervention floor rated 100% agreement in the “quietness in hospital environment” statement on their survey 48% of the time, compared to 14% among patients that stayed on the 2100 control floor.

Conclusions: A shift from 2100 to 0500 laboratory collection resulted in improved resident satisfaction, likely because the ownership of intervening on results was placed on the appropriate day team. Additionally, nurses participating on the 0500 intervention floor had a higher satisfaction compared to those on the control floor. Furthermore, this shift did not result in a prolonged length of stay and even resulted in a higher rate of 10 am discharge orders being placed. Finally, the shift to 0500 labs resulted in an increased perception of the hospital’s quietness.

IMAGE 1: Satisfaction survey results among providers on general practice units (GPU) with morning (blue) and evening (orange) laboratory collection time

IMAGE 2: Length of stay and discharges before 10 am of patients undergoing morning collection as compared to 2021 and 2019 evening laboratory collection