Quality Improvement in the Coagulation Laboratory: Reducing the Number of Insufficient Blood Draw Specimens for Coagulation Testing.
OBJECTIVE
To report the efforts of our laboratory to reduce quantity-not-sufficient (QNS) specimens via several methods and to directly measure the effect of expired collection tubes on the amount of blood that can be drawn.


METHODS
We tracked the number of QNS venous-blood specimens per month received by our coagulation laboratory from March 2008 to December 2012. Interventions involved communications that informed nurses and phlebotomists how to avoid drawing QNS specimens and floor sweeps, in which laboratory staff searched for and removed expired vacuum-based blood-collection tubes (VBCTs) from inpatient hospital floors. Also, we assessed 11 healthy donors to determine the amount of blood that could be drawn into expired VBCTs.


RESULTS
During the study period, the rate of QNS specimens dropped from a mean of 0.7% to 0.3%. In expired VBCTs collected from healthy donors, we observed a statistically significant difference in the amount of blood drawn into nonexpired vs expired VBCTs (P <.001). Also, there was a negative relationship between the number of months that the VBCT had been expired and the amount of blood that could be drawn into the VBCTs (P <.001). For every month that VBCTs were expired, the amount of blood drawn decreased by approximately 1.8 mm (0.1 mL), using linear regression analysis.


CONCLUSIONS
Our evidence strongly suggests that expired VBCTs consistently and progressively yield QNS specimens. Methods to reduce blood draws from expired VBCTs may include communications promoting proper blood draw technique, floor sweeps to remove expired VBCTs, and improved inventory management.
Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan.
Grace
G
Bostic
Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan.
Rebecca
R
Thompson
Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan.
Stefani
S
Atanasoski
Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan.
Carrie
C
Canlas
Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan.
Hong
H
Ye
Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan.
Mark
M
Kolins
Department of Clinical Pathology, William Beaumont Hospital, Royal Oak, Michigan mdsmith@beaumont.edu.
Marc D
MD
Smith
D001780:Blood Coagulation Tests / Q000295:instrumentation / Q000592:standards*; D001800:Blood Specimen Collection / Q000295:instrumentation / Q000592:standards*; D006801:Humans; D007753:Laboratories / Q000592:standards*; D058996:Quality Improvement