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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Less is More: Time to Discontinue Redundant Processes

Published August 3, 2014 7:28 PM by Glen McDaniel

As laboratorians we tend to be masters (and mistresses) of multitasking and completing tasks. Ever wondered why we have so many checklists, worksheets and forms? Computerization has simply moved some of that documentation to a new format.


OK, so as scientists we do need to have checks and balances, we must document, we must meet regulatory requirements. However too often we have become slaves of “always doing something and writing it down.”  We proudly use “if it’s not documented it wasn’t done” as a mantra.


A few years ago, I reviewed some point of care (POC) documentation on the nursing floor of a hospital and found out that for an entire week, quality control was out on several tests, yet the nurses performed patient testing daily anyway. The Director of Nursing defended her nurses by saying her nurses followed the laboratory policy of “performing QC daily.” It took several attempts to convince intelligent healthcare providers that the laboratory did not simply want them to complete a task to be checked off on a list. They had to go one step further and evaluate the each QC result to make sure it was in range/acceptable; or troubleshoot and correct the problem until the QC was in range. Then (and only then) should patient results be performed.


I am not suggesting that any laboratorian would be guilty of such an act, but it does point out how task-obsessed we can be. We sometimes have procedures or old practices that have long outlived their usefulness and logic. I consulted for a laboratory that had worksheets for every test, although some instruments were interfaced with the LIS. Other manual test results were entered directly into the computer along with the QC result.  Yet they had all these reams of manual worksheets. Asked why, the over-worked staff responded in various ways: the state required it, it was a CAP standard, or they needed to be able to pull monthly volumes of each test performed. As I drilled down, one honest person finally admitted, “We have always done it that way so I don’t want to be the one to break the pattern, just in case.” Just in case of what?


Another lab I know of has a policy that requires that 5 different "licensed individuals" check blood for transfusion: an MT/MLS rechecks the phlebotomist, another MLS verifies the correct units are documented and tagged, an RN (not even an LPN) signs out the blood  at the blood bank with an MLS, and then cross checks the unit with another RN before the blood is hung.  That sounds pretty safe, but it is a very labor intensive process. Worse it does not do what it purports to do. Supposing the phlebotomist draws the wrong patient (that’s not checked), suppose the first MLS tags the wrong unit of blood (the second MLS visually verifies the blood type and unit numbers not the actual crossmatch), the nurse signing out the blood again does the same thing (just verifies the numbers in the sign-out log matches the units in her hand. The nurses hanging the blood cannot verify that was in fact the patient the phlebotomist drew. So a long, complicated process with lots of paper and several signatures does not always ensure quality.


Part of quality assurance should be to examine processes on a regular basis to see what purpose they actually serve: clinical, quality, regulatory, financial, or something else. Can you get volumes or data from the computer instead of hanging on to a manual 15 year old worksheet for example? Could you simplify that bloodbank process while ensuring greater greater patient safety?


CMS as well as regulatory agencies like CAP constantly revisit issues like the need to run QC: how many levels and how frequently. What documents need to be maintained and for how long? Is any process causing undue hardship, eating up too much staff time and is too labor intensive?


As we try to reduce costs, do more with less and try to bring some relief to an older, tired and overworked workforce, we need to re-examine processes for redundancy. If you cannot give a valid reason related to patient care, quality, regulatory or financial requirement, then rethink that process you are hanging on so tenaciously. Even processes that need to be continued still need to be examined to see if they can be revamped or streamlined in some way. Some processes can be discontinued, modified or documented in simpler ways or via an electronic format (versus paper).


Having a worklist to complete or because we have always done it this way are no longer valid reasons for retaining and perpetuating those long-standing process.


Press Start: Lead an Empowered Life as a Clinical Laboratorian : Less is More: Time to Discontinue Redundant Processes

September 13, 2014 6:15 AM

I have been a traveling tech for a few years and I have given up on trying to understand the things that diffrent labs do.

Some will listen when I share experiences or suggest better ways of doing things but most are very resistant. Like several labs I know have policies such as check timers periodically, but some of those same labs dont follow their own policy. One lab said check timers every month. They just check off the list "done"  but no one actually does the check.

Another lab I worked at checked their timers by lining them all up and using a stop watch They would set a timer like for 5 minutes and then start the stop watch and see how long it took that timer to ring 5 minutes. But for the time I was there they made no adjustment although the timers were all different and slightly off from the stop watch.

They accepted it because it was only "slightly off" but they had no tolerance/acceptable limits written anywhere and they tried to argue that for most tests the time does not have to be 100% accurate. So then, why do they have to check their  timers in such detail and so freqquently?

Of course most people use the CAP as an excuse whenever they cant come up with a  good reason. As I travel around I have seen so many tasks and so much documentation in different labs that no one can explain to me. Many labs waste time and effort just out of habit.

John T. MT (AMT) August 5, 2014 3:18 PM
Detroit MI

Wow. That is so true. Every place I have worked there are  practices like that. Everyone hates them and  no one knows why they do them.

Then there is always one person who says, That is the way we have always done it. That drives me crazy.

The problem is that some of the worst are the lab managers. They want to keep stuff the old way because they are not the ones who have to do it. Then they might be just scared of change. What do you do when it is the leaders who insist on keeping everything the same-for no good reason?

Myryam MT(ASCP) August 3, 2014 10:05 PM
Decatur GA

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