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

Yu Kyung Kim; Kyung Eun Song; Won-Kil Lee

doi:10.3343/kjlm.2009.29.2.171

Journal List > Korean J Lab Med > v.29(2) > 1011535

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

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

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.

Go to :

Keywords: 6 Sigma, Customer, Waiting Time Reduction

REFERENCES

1.Harry M, Schroeder R, editors. Six sigma: the breakthrough management strategy revolutionizing the world's top corporations. 1st ed.New York: Doubleday Business;2000. p. 299.

2.Westgard JO. Six sigma quality: performance metrics vs. laboratory myths. AACC presentation. 2002. http://www.aacc.org/events/expert_access/2002/westgard/Pages/presentation.aspx.

3.Westgard JO., Klee GG. Quality management. Burtis CA, Ashwood ER, editors. , eds.Tietz textbook of clinical chemistry and molecular diagnostics. 4th ed.Philadelphia: Elsevier and Saunders;2006. p. 488–90.

4.Gras JM., Philippe M. Application of the six sigma concept in clinical laboratories: a review. Clin Chem Lab Med. 2007. 45:789–96.

5.Riebling NB., Tria L. Laboratory toolbox for process improvement: six sigma at north shore-long island jewish health system. Lab Med. 2008. 39:7–14.

6.Nevalainen D., Berte L., Kraft C., Leigh E., Picaso L., Morgan T. Evaluating laboratory performance on quality indicator with the six sigma scale. Arch Pathol Lab Med. 2000. 124:516–9.

7.Westgard JO., Westgard SA. The quality of laboratory testing today: an assessment of σ metrics for analytical quality using performance data from proficiency testing surveys and the CLIA criteria for acceptable performance. Am J Clin Pathol. 2006. 125:343–53.

8.Simmons JC. Using Six Sigma to make a difference in health care quality. Qual Lett Healthc Lead. 2002. 14:2–10.

9.Riebling N., Tria L. Six sigma project reduces analytical errors in an automated lab. MLO Med Lab Obs. 2005. 37:22–3.

10.Jackson J., Woeste LA. Using lean six sigma to reduce patient wait times. Lab Med. 2008. 39:134–6.

Go to :

Fig. 1.

Graphical display of analysis of defective details using Pare-to chart.

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.

Fig. 3.

Changes of sigma performance (▴) and waiting time (▪).

Fig. 4.

Changes of average waiting time of the day (♦, February 2007; ▪, December 2007; ▴, July 2008).

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

TOOLS

Similar articles