Reducing the number of clinical stat phlebotomy orders: feasible or not?

Abstract

Abstract Background: To manage the costs and performance of diagnostic services involving laboratory testing permanent evaluation is required. Among these, the ever increasing use of stat ordering, involving labour intensive phlebotomy, warrants explanation, especially for a phlebotomy service organised by the laboratory, not by those responsible for and/or carrying out the requests, such as doctors and nurses. Methods: To explore the possibilities to reduce the number of stat phlebotomy requests, we conducted a survey among nurses and doctors of their motives in requesting 109 randomly selected stat orders. Results: Fifty-five percent of all stat phlebotomy orders were requested for immediate decision-making with respect to urgently required diagnosis and patient care, defined by us as medical reasons. The other 45% of the stat orders were made for logistical reasons relating to the patient care or the hospital organisation. In total, 19 phlebotomy requests (17%) were unnecessary and could have been avoided. For most of the stat phlebotomy orders alternatives were not possible, as only 2% of the requests could have been replaced by analysis in material that had been withdrawn earlier. Conclusions: The majority of the stat orders for phlebotomy were requested for good reasons, about equally distributed among the medical and logistical needs. This sets limits to the measures being feasible to further improve stat phlebotomy ordering efficiency, taking into account the way of functioning of modern hospital care.