Structuring Phlebotomy Teams

More hospitals opt for centralized teams to foster teamwork, minimize error

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Breaking the silo mentality is a huge focus in healthcare, and nowhere is this more evident than in the phlebotomy lab.

In the 90s, phlebotomists would commonly be assigned to one area of the medical center, with the thinking that they'd take ownership of lab work in a given department. Today's phlebotomists often work in the exact opposite setting: a centralized lab for with colleagues supporting one another and answering orders throughout the hospital.

Mohammed Mustafa, systems engineer, Mayo Clinic Department of Lab Medicine, has worked long enough to see many of these healthcare workforce trends come and go.

Approximately 8 years ago, he explained, St. Mary's Campus of Mayo Clinic Hospital followed a national trend and stationed phlebotomists at different areas of the hospital.

"The idea at this time was that, if a patient within these areas needs a phlebotomist, the phlebotomist knows the service area and is quick to respond to these blood draws," he explained.

Though this cut down on the number of new faces walking into the patient room, some drawback to the regionalized setting quickly became apparent, Mustafa said.

"Once the phlebotomist's shift starts, he goes on location and nobody knows what he's doing," he said

"The bigger team has no idea what's going on. We also had vastly different workloads so a phlebotomist in one area had a light workload while another was overwhelmed. It was hard to balance."

In trying to equalize the workloads, the medical center began studying a centralized model and made the shift in 2008.

"All phlebotomists are in a centralized location and just respond to orders during the day like an airplane control center," Mustafa explained. "There's very good teamwork and you can easily get help from a colleague if needed. In downtime, they brush up in their skill set or perform their administrative, non-phlebotomy work."

The only real snafu, Mustafa said, is that the technician is walking more. In a 1,265-bed hospital, the number of steps is increased significantly and that can cut down on productivity very quickly.

As a lucky break, this shift in phlebotomy structure came around the same time as the electronic medical record.

"When someone goes to a more distant location in the hospital, we try to make sure they can stay longer," he said. "Our system allows us to look ahead when orders are placed. We can see what work is pending within the next 30 minutes and group our travel."

The additional walking is the only real problem and Mustafa said the benefits outweigh this inconvenience. He counts himself lucky at Mayo that in-patient and outpatient are completely different services. At smaller hospital, he noted, a centralized staff has to go back and forth servicing both areas.

Though their accidental needle stick rate is low anyway (approximately 0.05%), Mustafa believes a centralized phlebotomy structure adds an extra layer of safety.

"There are fewer errors in a centralized approach because you can ask co-workers for help," he reasoned. "In a regionalized structure, you're on your own. Most of the time, when you have too much work in too short of time, it's when accidents happen."

Hybrid Approach
A growing number of institutions split the difference and adopt a hybrid structure for their lab, meaning phlebotomists work together servicing two or more locations. Rush University Medical Center in Chicago chose this option. For Carole Robinson, phlebotomy supervisor, the on-campus walking isn't a problem but using agency phlebotomists to fill vacancies is a double-edged sword.

"Sometimes, the need is great if we have people on maternity leave, etc. and an outside agency can give us help quickly. They conduct background checks and verify licensing," she said.

Although Rush pays triple for agency phlebotomists than they would in-house staff, there's always a shortage of phlebotomists so it's necessary to maintain safe patient care.

A major disadvantage occurs frequently when agency phlebotomists mis-represent their training.

"They might say they can draw everything. When they get here, it turns out that they only drew for babies years ago and have lost that skill. Then, we have to move our own phlebotomists around. A lot of the time, we just keep the (agency) phlebotomist and use her somewhere else because the contract would end in the time it would take the agency to replace her," Robinson said.

In a busy, urban medical center, patient issues are complex and it's easy for phlebotomists to experience frustration.

"A lot of them leave because they don't have compassion," Robinson said. "People say they'll focus first on the patient and totally change 6 months later. We have patients who throw things and make derogatory comments about minority staff. I tell our staff not to take it home with them. You just don't know what that patient's going through, physically, mentally or emotionally."

Robin Hocevar is on staff at ADVANCE. Contact rhocevar@advanceweb.com.


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