Hospitals must adhere to CDC physical distancing requirements when managing patients throughout their facilities, and these new demands are no different in the outpatient laboratory. Frequently, laboratory waiting space can be limited, causing bottlenecks in service and delaying patient care. When factoring in physical distancing due to the coronavirus pandemic, the necessary reduction of seats in lab waiting areas only exacerbates the problem.
In order to alleviate this congestion, Children’s Mercy Hospital of Kansas City has implemented a fast-track service for clinic patients requiring laboratory services at their Broadway Clinics. This service uses a touch-free sign-in process and provides a technician phlebotomist as a “Lab Concierge” to escort clinic patients from the waiting room to the lab collection area and back. Walk-in patients requiring registration are provided additional space in the waiting room by removing clinic patients from the area. This process has significantly reduced phlebotomy turnaround times and has become a satisfier for both patients and employees. As Children’s Mercy Hospitals and Clinics now only allows one caregiver to enter a facility with the patient, this process is particularly valuable for our patient population. Herein we discuss how this process came about.
New and Unexpected Challenges
Before the Coronavirus pandemic, clinic inpatients would come down for laboratory services and wait in line with the walk-in patients. This first-come-first-served process did not consider that the clinic patient may have been at the facility for several hours and led to an unnecessary double-check in.
With the onset of the viral pandemic and the emerging need for physical distancing of patients and employees in our facilities, patient waiting areas became a safety risk. Seating options were reduced and wait times were scrutinized as we began to focus on no-touch no-wait throughput. Before the pandemic, this waiting space utilized by multiple departments was managed by one patient access staff member using electronic check-in tracking software. The data entry process was performed on a touchscreen by the patient/caregiver and was managed by the single staff member who created patient registrations for walk-ins. Given the new bottlenecks, this process had to be addressed to improve throughput and successfully promote physical distancing in our new environment.
Determine Root Causes
The laboratory started by creating a fishbone diagram to look for issues causing suboptimal patient/family experiences in outpatient laboratory services (see FIGURE 1). In our case, we focused on delays due to new requirements, backlogs, and missed communication. Delays were primarily caused by requirements including COVID-19 screening, waiting for proper lab orders, and the time required to register walk-in patients or review whether the patient was from the clinic. The second major delay causing backlogs included negotiating the workload of the busy patient access staff member and the workload of our lab phlebotomy team, which must cover all patients—both clinical and walk-in.
Lastly, our communication plan for logging and transmitting patient information was reliant upon our check-in software for patient tracking. Without the touchscreens (due to COVID-19 concerns), we needed a different way to enter the information for all patients needing laboratory services. FIGURE 1 provides more detailed examples of issues that led to a suboptimal patient experience.
Introduction of the Lab Concierge
Hotels are well known for their use of concierge services to improve customer experiences in their business model. As health care systems begin to rely heavily on patient feedback, the idea of a lab concierge role aligns with the outcomes we want to achieve in providing an exceptional patient experience. The lab concierge is a laboratory technician (LT1) trained in phlebotomy and specimen processing, and the role rotates through all our LT1 staff throughout the day. The remaining LT1s are positioned in the draw rooms to acknowledge the alert when a patient arrives, check patient orders, and print labels.
The lab concierge facilitates patient access by entering their information into the check-in software as the patient arrives and can assign the patient to a phlebotomy room based on availability. The check-in software notifies a specific LT1 in a draw room who can then begin preparing for the collection as the lab concierge escorts the patient and caregiver back. Door signs mounted outside the draw rooms show which rooms are occupied with patients.
Program Data Analysis and Results
After 2.5 months of outpatient throughput data monitoring, the laboratory has seen a definite improvement in phlebotomy turnaround times (TATs). With clinic outpatients able to come directly into the room for collections, wait times have been reduced by half. Walk-in outpatients continue to follow the standard registration process used pre-pandemic. We have even managed to reduce overall TATs for blood collections to levels below pre-COVID-19. Before the pandemic, we saw 85% of collections completed within 15-20 minutes from check in; whereas now we see 82% completed in less than 10 minutes. Additionally, TATs documented for walk-in outpatients have decreased significantly (see FIGURE 2).
Positive Feedback and Staff Satisfaction
The laboratory concierge concept at the Children’s Mercy Broadway Clinics has been a great success. Prioritizing patients to improve throughput and decrease exposure in cramped waiting areas has allowed us to maintain 6-foot physical distancing restrictions imposed by the hospital. The lab concierge helps facilitate this important workflow, decreasing the demands on patient access registration and providing a friendly face from the beginning and throughout the patient experience. Stationing the LT1 inside the draw rooms with computer capabilities also has decreased collection TATs and has freed up additional workspace in the lab for our medical laboratory scientists.
The lab concierge model has improved the patient experience while also conforming to COVID-19 physical distancing requirements. We have received positive feedback from families who appreciate the extra level of service and the circumvention of the waiting room. Likewise, our laboratory staff appreciate enabling a positive, patient-facing experience while being able to better practice social distancing by leaving the laboratory and utilizing their skills in another area.
With the structure and delivery of health care evolving each day during the pandemic, we are continually evaluating how to best provide laboratory services for our patients. We believe that the lab concierge has provided a significant improvement to our patients and staff during this time of uncertainty.
Sean Tucker, MLS(ASCP), MBA, is the manager of Limited Services Laboratories at Children’s Mercy Hospital Kansas City. He is the past President of the Heart of America chapter of CLMA and is currently on the CLMA Board of Directors leading the Chapter Advisory committee. A 2007 graduate of the CLS school at the University of Kansas Medical Center, he has been recognized as an ASCP “Forty under 40.” He received his MBA from Rockhurst University in 2011.
Terri Johnson MLS(ASCP), is the laboratory supervisor at the Children’s Mercy Hospital Broadway Clinics Laboratory. She oversees laboratory operations for several clinics including primary care, teen, and endocrinology services. Terri is a member of the CLMA Heart of America Chapter.
JDL Nolen, MD, PhD, MSPH, works in the Department of Pathology and Laboratory Medicine at Children’s Mercy Hospital where he is the director of the Biorepository (CRIB) and the director of the Limited Services Laboratories. He is licensed in Kansas and Missouri, and is certified by the American Board of Pathology in clinical informatics, clinical pathology, and transfusion medicine. Dr. Nolen is co-chair of the Orders and Observations Working Group at HL7 and participates in the CLSI and the DICOM Workgroup. At Children’s Mercy Hospital, he chairs the Lab Utilization Committee and serves on the Genetic Appropriate Testing Committee (GATE).
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