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Kim, Song, and Lee: Reducing Patient Waiting Time for the Outpatient Phlebotomy Service Using Six Sigma
Original Article

Korean J Leg Med 2009;29(2):171-177.

Published online: 14 February 2009

DOI: https://doi.org/10.3343/kjlm.2009.29.2.171

Reducing Patient Waiting Time for the Outpatient Phlebotomy Service Using Six Sigma

Yu Kyung Kim, M.D., Kyung Eun Song, M.D., Won-Kil Lee, M.D.

Department of Clinical Pathology, Kyungpook National University School of Medicine, Daegu, Korea

Corresponding author: Won-Kil Lee, M.D. Department of Laboratory Medicine, Kyungpook National University Hospital, 50 Samdeok-dong 2-ga, Jung-gu, Daegu 700-721, Korea Tel: +82-53-420-5292, Fax: +82-53-426-3367 E-mail: leewk@knu.ac.kr

Received 19 August 200826 February 2009       Accepted 27 February 2009

Copyright © 2009 by the Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

One of the challenging issues of the outpatient phlebotomy services at most hospitals is that patients have a long wait. The outpatient phlebotomy team of Kyungpook National University Hospital applied six sigma breakthrough methodologies to reduce the patient waiting time.

Methods

The DMAIC (Define, Measure, Analyze, Improve, and Control) model was employed to approach the project. Two hundred patients visiting the outpatient phlebotomy section were asked to answer the questionnaires at inception of the study to ascertain root causes. After correction, we surveyed 285 patients for same questionnaires again to follow-up the effects.

Results

A defect was defined as extending patient waiting time so long and at the beginning of the project, the performance level was 2.61 sigma. Using fishbone diagram, all the possible reasons for extending patient waiting time were captured, and among them, 16 causes were proven to be statistically significant. Improvement plans including a new receptionist, automatic specimen transport system, and adding one phlebotomist were put into practice. As a result, the number of patients waited more than 5 min significantly decreased, and the performance level reached 3.0 sigma in December 2007 and finally 3.35 sigma in July 2008.

Conclusions

Applying the six sigma, the performance level of waiting times for blood drawing exceeding five minutes were improved from 2.61 sigma to 3.35 sigma.

Keywords: 6 Sigma, Customer, Waiting Time Reduction

REFERENCES

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Fig. 1.
Graphical display of analysis of defective details using Pare-to chart.
kjlm-29-171f1.tif

Abbreviations: a, space arrangement of phlebotomy station; b, waiting times; c, location of phlebotomy station; d, laboratory information; e, solution on customer's inquiry; f, friendliness of the phlebotomist; g, skill of the phlebotomist; •, cumulative percentage.

Fig. 2.
Percentage distribution of patient satisfaction with time spent in the phlebotomy station.
kjlm-29-171f2.tif
Fig. 3.
Changes of sigma performance (▴) and waiting time (▪).
kjlm-29-171f3.tif
Fig. 4.
Changes of average waiting time of the day (♦, February 2007; ▪, December 2007; ▴, July 2008).
kjlm-29-171f4.tif
Table 1.
Selected root causes using X-Y matrix, FMEA and after noise elimination
Root cause Statistical analysis methods P value
Data analysis    
 1. Day of the week One-way ANOVA <0.05
 2. Time of the day Pearson's coefficient test <0.05
 3. Specimen transportation t-test 0.34
 4. Absence of receptionist Mann-Whitney U test <0.05
 5. Explanation to the patient Mann-Whitney U test <0.05
 6. Soothing a frightened child Mann-Whitney U test <0.05
 7. Conduct of clinician Mann-Whitney U test <0.05
 8. Specimen for the radioimmunoassay Mann-Whitney U test <0.05
 9. Wrong or duplicate test order t-test <0.05
 10. Telephone inquiries Mann-Whitney U test <0.05
 11. Put specimens to the incubator t-test for cold agglutinin test t-test 0.87
 12. Time spent performing bleeding time test Mann-Whitney U test <0.05
Understanding of the existing condition    
 1. Toilet directions    
 2. Confirmation of stat specimens    
 3. Collecting misplaced urine specimens    
 4. Insufficient direction of specimen submitting area    
 5. Take off one's jackets at the phlebotomy table    
 6. Failure to stop bleeding after phlebotomy    
 7. Picking up used alcohol swab    

Abbreviation: FMEA, failure mode and effects analysi.

Table 2.
Final improvement proposal for each last root cause
Last root cause Final improvement proposal
1. Time of the day Reinforcement of return of inpatient phlebotomist after collection of specimens
2. Specimen transportation Automation of specimen delivery system
3. Absence of receptionist Addition of receptionist
4. Explanation to the patient Addition of receptionist
5. Soothing a frightened child Preparation of blood collecting area for pediatric patient
6. Inadequate information by clinicians Addition of receptionist
7. Specimen for the radioimmunoassy Addition of receptionist
8. Wrong or duplicate test order Computerized alert for duplicate requests
9. Time spent performing bleeding time test Substitution for bleeding time test
10. Toilet directions Direction sign preparation
11. Confirmation of stat specimen Request to mark on the specimen bar-code
12. Misplacement of urine specimen Direction sign preparation
13. Insufficient information of specimen submitting area Addition of receptionist
14. Take off one's jackets at the phlebotomy desk Addition of receptionist
15. Failure to stop bleeding after phlebotomy Applying band aid
16. Picking up used alcohol swab Addition of receptionist
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