title: Using Lean-Six Sigma to reduce hemolysis in the emergency care center in a collaborative quality improvement project with the hospital laboratory.
abstract: BACKGROUND
  As part of a strategic quality improvement plan, laboratory management at Sarasota Memorial Health Care System (SMHCS) focused its efforts on improving preanalytical work flow and blood collection processes-both negatively affected by hemolyzed specimens. When hemolysis is detected in a blood specimen, blood may need to be re-collected, resulting in bottlenecks and rework all along the value stream. From July through December 2009, hemolysis averaged 9.8% in the Emergency Care Center (ECC) and 3.4% housewide. The goal was set to reduce hemolysis to 2%.
  
  
  METHODS
  The project team identified hemolysis as one of seven factors contributing to non-value-added activities and bottlenecks in blood collection and preanalytical processes. Observations and interviews helped to identify error-prone practices and process variation. To verify the root causes of hemolysis, the findings were compared against best practices. The team developed a housewide protocol, standardized collection processes, created competency-based training, and enhanced ECC hiring practices.
  
  
  RESULTS
  During December 2010-March 2011, following initial housewide interventions and ECC self-sustaining solutions, ECC hemolysis decreased by 91%-from 9.8% (423 hemolyzed/4,295 collected) to 0.88% (58 hemolyzed/6,560 collected). Housewide hemolysis decreased by 59%-from 3.4% (2,046 hemolyzed/60,307 collected) to 1.39% (619 hemolyzed/44,528 collected). Since the project, hemolysis has continued to trend downward; the mean percentage has consistently been < .05% for the ECC and < 1% housewide.
  
  
  CONCLUSIONS
  Lean-Six Sigma tools helped to pinpoint hemolysis as a key inefficiency in blood collection and preanalytical work flow. Although focused on the ECC, the project team standardized blood collection practices and instituted quality devices to achieve hemolysis reductions housewide.
authors.affiliation: Sarasota Memorial Health Care System, Sarasota, Florida, USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Damato
authors.forename: Dana
authors.initials: D
authors.lastname: Rickard
mesh_terms: D002985:Clinical Protocols; D003299:Cooperative Behavior; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D006461:Hemolysis; D006801:Humans; D007318:Inservice Training; D007755:Laboratories, Hospital / Q000458:organization & administration* / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D013048:Specimen Handling / Q000379:methods* / Q000592:standards*