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Context: Phlebotomy services are a common target for preanalytic improvements. Many new, quality engineering tools have recently been applied in clinical laboratories. However, data on relatively few projects have been published. This example describes a complete application of current, quality engineering tools to improve preanalytic phlebotomy services., Objectives: To decrease the response time in the preanalytic inpatient laboratory by 25%, to reduce the number of incident reports related to preanalytic phlebotomy, and to make systematic process changes that satisfied the stakeholders., Design: The Department of Laboratory Medicine, General Services Section, at the University of Texas MD Anderson Cancer Center (Houston) is responsible for inpatient phlebotomy in a 24-hour operation, which serves 689 inpatient beds. The study director was project director of the Division of Pathology and Laboratory Medicine's Quality Improvement Section and was assisted by 2 quality technologists and an industrial engineer from MD Anderson Office of Performance Improvement., Results: After implementing each solution, using well-recognized, quality tools and metrics, the response time for blood collection decreased by 23%, which was close to meeting the original responsiveness goal of 25%. The response time between collection and arrival in the laboratory decreased by 8%. Applicable laboratory-related incident reports were reduced by 43%., Conclusions: Comprehensive application of quality tools, such as statistical control charts, Pareto diagrams, value-stream maps, process failure modes and effects analyses, fishbone diagrams, solution prioritization matrices, and customer satisfaction surveys can significantly improve preset goals for inpatient phlebotomy.

Researchers evaluated a differential tube solubility test's ability to detect Hemoglobin S (Hb S) in sickle cell conditions. Six hundred twenty-nine blood samples, including 190 S hemoglobinopathies, were used to assess test performance. Alkaline cellulose acetate electrophoresis was used to confirm all results. The test correctly indicated the presence of Hb S in every case in which Hb S was found on electrophoresis. Six of the 198 specimens containing Hb S incorrectly differentiated the heterozygous from the homozygous state (two with Hb AS, three with Hb SF, and one with Hb SC). Electrophoresis later showed four of these samples to be inappropriate for solubility testing. Three of these specimens contained Hb SF and the other specimen contained Hb SC. One specimen from a patient with polycythemia gave a false positive result. Results were compared using different methods of centrifugation. This solubility test was found to be dependable as a screening method provided the manufacturer's directions are followed and all positive results are confirmed by electrophoresis.