As a busy oncology outpatient clinic, we run a lot of blood tests here in the Point-Of-Care lab. Of the 13,865 CBC tests we ran for the year ending on 8/31/17, we had 1,088 Blastocyte exceptions.
These Blastocytes exceptions (we call them Blasts) cause delay with the staff giving treatment, and create pages providers hate to get, because providers generally get so many pages (such is the nature modern American health care). It may seem funny that less than 8% of the total tests demand attention, but these delays and page callbacks cause disproportionate resentment among staff and providers. Relieving this strain would be more efficient and make them happier.
So I wondered how to cut down on delays when blastocytes happened. This would help the clinic run smoother and make providers happy because they have less page callbacks.
Like all labs, we run by protocols and there are protocols for the Blasts. Sometimes exceptions call for the sample to be run at the core lab (the main lab) for verification. But oftentimes they don’t. In fact most don’t. But there was a delay every time.
I decided to observe and tally the Blastocyte exceptions for two weeks and see how many of them were sent to the core lab. As it turned out, less than half were ordered to be sent down (38 Blasts with 17 being sent to core). Meaning most results with Blasts would go to the chart anyway, where staff could start treatment right away based on the result parameters that were now in the chart. Instead of waiting for the callback that most of the time said to not send the test down to the core lab, staff could start treatment without waiting for the provider callback. And it would mean providers would get an FYI page that most of them didn’t have to act on. Sometimes, but less than half, they would have to call back, but most would not and simply just delete the FYI page from their pager. No callbacks most of the time. And every time the results would immediately go to the chart where the staff could use them.
There was the issue of what about the lab test charge that the patient’s insurance would incur when the Blast result was sent to the chart and then sent to the core lab as well. This is a duplication of services, which is a big no-no. Since I regularly contacted, for other matters, the office that removes charges from patients’ bills, I asked them how much burden would it be to remove the occasional charge of the already-charted results when the CBC needs to be sent to the core lab. They said it wouldn’t be an issue unless they got to be too many. It was unlikely that they would be so it would be easy to email the office to have the charge removed for the ones sent to core.
With all these factors in place, I approached the clinic’s Medical Director, asking him if we could change the Blast protocol (since the lab lives by protocols!) to this new way to handle Blasts. He was most favorable to the providers getting fewer pages that required callbacks. He also saw the advantage of quicker treatment turnaround times for patients.
We allow room in the protocol for providers to have their Blasts treated their way. For example, one particular provider wants her Blasts automatically sent down every time. And another, who works with near-term post-transplant patients, wants to be asked every time before releasing to the chart or sending it to core.
I’m glad to have this new protocol in place. While most staff and providers may not recognize the favorable impact this has on their workday, it helps the clinic run smoother and relieves a bit of stress for staff and providers.
It feels good to create change that improves my workflow and perhaps more importantly helps the clinic run more efficiently. Where we all come out ahead.