Case Study: Improving Workflow in the Pre-examination Phase of Testing

According to reliable data pre-examination errors account for approximately 60 - 70% of all problems occurring in laboratory diagnostics, most attributed to mishandling procedures during collection, handling, preparing, or storing the specimens.¹² Errors also occur during the logging in of samples before they are transported to the specific departments, where testing is set to occur. Most of the errors occurring in the pre-examination phase are detected during the process, but each error causes a delay in workflow. The pre-examination phase of testing begins with a provider ordering a lab test. The process results in the collection of the specimen, identification of the patient and specimen, transportation to the laboratory, receiving of the specimen, and finally sending it to the appropriate lab (or department) where it will be prepared for analysis.

North Star Lab (NSL) determined that there were too many errors occurring in the pre-examination phase, as well as the possibility of other factors slowing down workflow. A team was formed, and a root cause fishbone analysis and Five Whys were employed to solve the problem. The team consisted of representatives who participated in all activities in the pre-examination phase, as well as the supervisor. Feedback from nurses and providers was also sought. The team created a baseline fishbone diagram of the processes in the pre-examination phase in which they could study and make suggestions (first image below). The team then identified each sequential step in the processes identified (second image below, or see attached for a larger copy). The team investigated each process and the steps identified to see where problems were occurring, or improvements could be made. They used the Five Whys strategy for each category on the fishbone figure.