Clinical Application of a Safe Blood Sampling Device with an Indwelling Needle

Background

The traditional indwelling needle catheter is hard and can only complete one puncture at a time. The safety and indwelling needle catheter is soft, with a large lumen, with high success rate of blood collection, and one puncture completes two operations, so it is of important value and significance to study the new safety and indwelling needle. To explore the clinical utility of a novel blood collection device with indwelling needle for blood collection among pediatric patients.

Methods

A total of 300 children who were admitted to the children's hospital from March to June 2020 were selected and randomly divided into the control group (148) and the observation group (152). The control group received venipuncture using regular needles for infusion and blood collection. For the observation group, a modified indwelling needle device was used for the procedures. Comparisons were made between the two devices in five aspects: blood sample quality, operation time, needlestick incidence, related complications, and patient satisfaction.

Results

There was no significant difference in coagulation rate between the two groups, but slightly lower overall hemolysis incidence in the observation group. The unqualified rate of blood specimens collected in the observation group was 10.0% lower than that in the control group (P < 0.05). Shorter operation time, lower incidence of needlestick injuries, and improved satisfaction were observed in the group using the novel blood collection device.

Conclusions

This modified blood collection device is superior to the regular venipuncture needle, in terms of safety, efficiency, and patient satisfaction; thus, it has potential for broad clinical applications for infusion and blood collection.

How Anxiety Our Adult Patients Before Venepuncture Procedure: A Study in UiTM Medical Centre Sungai Buloh (UiTMMC)

Background: Venepuncture is one of the commonest stressful invasive procedures in the health care setting. Unfortunately, to date, there was a lack of locally published studies that studied anxiety, especially before the procedure among adult patients. Hence, this study was conducted to determine the factors associated with the state and trait-anxiety among adult patients before the venepuncture procedure in UiTMMC. Methods: A cross-sectional pilot study was conducted among patients while waiting for a venepuncture procedure in March 2020. Patients aged 18 years old and above, Malaysian, able to understand English or Malay and had experienced venepuncture in UiTMMC were recruited. Malay validated version of the State-Trait-Anxiety-Inventory (STAI) Questionnaire was used to assess the anxiety level. Data were analysed using IBM SPSS Version 26.0, and multiple linear regression was used to determine the associated factors for state and trait-anxiety before the venepuncture procedure. Results: A total of 330 patients with a mean age of 46.34 ± 14.34 years participated in this study. The mean of the state-anxiety score was 38.02 ± 14.25 and the mean trait-anxiety score was 36.46 ± 11.47. The correlation between state-anxiety and trait-anxiety scores was highly significant (r=0.870, p<0.001). Factors associated with state-anxiety and trait-anxiety contributed with 72.6% and 58.5% variances, respectively. Conclusions: Adult patients who waiting for venepuncture in were average low state and trait anxiety scores. Although the associated factors were majority non-modifiable, this finding still can instil awareness to the health care workers who are dealing with needle procedurals.

Canned Comments in the Hospital Laboratory Information System Can Decrease Microbiology Requests

OBJECTIVES

Phone calls to the microbiology laboratory can be to clarify culture results and provide education, but those calls also interrupt laboratory workflow. We characterized calls that the laboratory received and developed targeted comments to educate providers.

METHODS

Calls were logged and characterized, and we developed comments to address common call subjects. We applied the new comments to cultures and logged calls over the same interval the subsequent year. Data before and after implementation were analyzed.

RESULTS

Call volume decreased from 496 calls to 419 calls after implementation. There was a significant difference in level of training among callers (P < .005), but the nature of the calls did not change. Laboratory response showed an increase in release of previously generated data (eg, suppressed susceptibility results). Comments specifically developed to address intrinsic antibiotic resistance and common susceptibility patterns did not decrease call volume.

CONCLUSIONS

Implementation of comments in the laboratory information system decreased call volume, but targeted comments were less effective than anticipated.

Service Quality Improvement of Outpatient Blood Collection by Lean Management

OBJECTIVE

To explore the application effect of lean management in improving the quality of outpatient blood collection services.

METHODS

For this study, a total of 146,907 patients whose blood was sampled by outpatient services between April 2020 and September 2020 were selected. We analyzed the influence of various factors on the waiting time and satisfaction levels of the patients for blood collection and eliminated confounders based on the results of the analysis. Lean management for the outpatient blood collection service was implemented in July 2020. Thus, the 38,275 cases sampled on weekday mornings between April and June 2020 were selected as the ordinary management group, while the 39,473 cases sampled on weekday mornings between July and September 2020 belonged to the lean management group. Finally, the changes in waiting time and the satisfaction levels of the patients were evaluated.

RESULTS

The age and gender of the patients and the length of service of the staff, who administered blood collection had a negligible effect on the waiting time (Z=-1.243, P=0.418; Z=-1.569, P=0.389; Z = -1.062, P= 0.563), while there was a statistical difference in the waiting time between different days and different sessions (Z = -2.581, P = 0.013 and Z = -4.672, P < 0.001). We also found that the length of service of blood collection staff, day, session, and age and gender of patients did not have a meaningful effect on patient satisfaction (P > 0.05). Overall, the median waiting time of outpatients decreased from 22 min to 13 min after the implementation of lean management (Z =10.522, P < 0.001), while the satisfaction level of outpatients increased from 95.37% to 98.33% (χ ² = 559.580, P < 0.001).

CONCLUSION

The application of lean management can significantly shorten outpatient waiting time for blood collection, improve patients satisfaction levels, and enhance the overall patient experience. Thus, lean management can significantly improve the service quality of outpatient blood collection.

Laboratory Process Improvement: A Quality Initiative in an Outpatient Oncology Clinic

The goal of achieving maximum productivity through process redesign and teamwork in oncology laboratory (lab) operations can be challenging in cancer care organizations. At an urban cancer center, missing lab orders occurred frequently and led to increases in lab errors, turnaround time, and patient wait times. Patient and staff satisfaction metrics were also affected, resulting in suboptimal scores. A nurse-driven practice change project was initiated after a thorough assessment in two clinic sites. The application of targeted lean methodology to redesign lab processes and workflows, in addition to engaging multiple stakeholders, was implemented to support a culture of continuous quality improvement.

How to verify patient identity and blood product compatibility using an electronic bedside transfusion system

Transfusion of an incorrect blood component is an important avoidable serious hazard of transfusion resulting from process errors. Our group and others have taken advantage of new technology and developed electronic transfusion systems for safe transfusion practice in a previous studies. They allow the clinical staff to correctly identify the patient and the blood product at the bedside, ensuring the right blood product is given to the right patient. This video is to demonstrate the process and not to promote any specific product. It is a follow up our previous video clip on electronic remote blood issue in a previous study. The process for correct patient identification originates from the wristband, which contains the patient identification details in a 2D barcode and is printed from the electronic patient record system. These details are associated with the blood sample through using a portable printer to produce a label for the sample tube. The patient details are scanned into the blood bank laboratory information system (LIS) and are then printed on a compatibility label by the LIS, which also contains a 2-dimensional barcode, and is then attached to the blood product. Following an initial visual check of these details by the clinical staff, the electronic bedside system requires that both the patient wristband barcode and the blood product compatibility barcode are scanned. This will electronically verify at the patient's bedside that the right unit is to be given to the right patient. This is the final step in ensuring end-to-end electronic control and safe transfusion practice.

Cost and Visit Duration of Same-Day Access at an Academic Ophthalmology Department vs Emergency Department

Importance

Convenient outpatient access for ophthalmology patients seeking urgent care could offer savings compared with an emergency department (ED) visit.

Objective

To evaluate the costs and visit durations of same-day access (SDA) in an ophthalmology department at an academic medical center vs ED care.

Design, Setting, and Participants

This single-center study was a retrospective quality improvement analysis of an institutional electronic medical record system at the Wilmer Eye Institute clinics and the Johns Hopkins Hospital ED. On June 1, 2015, the Wilmer Eye Institute and Johns Hopkins Hospital initiated an official policy of providing SDA to patients calling for appointments (ie, the same-day project). All ophthalmology clinic locations created same-day appointment slots for at least 1 practitioner. In recognition of seasonal variations in patient visit volumes, the 10 months before implementation (August 1, 2014, to May 31, 2015) were compared with complementary periods in 2015 to 2016 and 2016 to 2017.

Main Outcomes and Measures

The study tabulated encounters, charges, and visit length for outpatients seen on the same day or by previously scheduled appointments. For the ED patients, volume, diagnoses, charges, and length of stay data were collected. The numbers of SDA patients who indicated urgency were tabulated.

Results

The number of SDA patients increased from 22 781 to 26 579 for the first year after SDA implementation. The mean charge was $258 (95% CI, $250-$266; median, $184; interquartile range [IQR], $175-$320), and the mean clinic transit time was 1.55 hours (95% CI, 1.54-1.57 hours; median, 1.28 hours). For patients seeking eye care in the ED, the mean professional fee was $401 (95% CI, $390-$411; median, $360; IQR, $255-$500), the mean (SD) total hospital charge was $1040 ($999) (95% CI, $729-$1079; median, $1002; IQR, $334-$1429), and the mean length of stay was 7.30 hours (95% CI, 7.01-7.57 hours; median, 7.20 hours). The top 4 ophthalmic diagnoses for ED patients were conjunctivitis, cornea abrasion, iritis, and visual loss, which were unchanged after SDA implementation. In calendar year 2017, a total of 4062 SDA patients reported urgency; their estimated savings in charges compared with an ED visit were $580 866 in professional fees and $3 176 484 in hospital charges.

Conclusions and Relevance

Same-day access appears to be less expensive and to require less time in the health care system than a visit to the ED for an ophthalmic diagnosis. Substantial savings in time and money might be achieved if urgent eye care is delivered in the clinic rather than the ED.