Routine blood tests are performed in the early morning hours at most hospitals. Timely review of those laboratory tests during morning rounds is critical for safe and efficient patient care. However, availability of those results for rounds is variable. The batched approach of morning blood specimens causes an unintended heavy workload for laboratory and nursing staff. An interdisciplinary committee comprised of medical, nursing, and laboratory department staff hypothesized that midnight blood draws could streamline workload and enhance earlier access of data to providers.
To assess the feasibility of midnight versus morning (6 AM) blood draws, patient satisfaction, turnaround time of laboratory tests, and workload distribution.
Patient preference for midnight or morning blood draws was assessed using a questionnaire. The survey (N = 100) showed 41 preferred midnight blood draws, 22 preferred morning blood draws, and 37 had no preference. This distribution was significantly different from random distribution favoring midnight blood draws (Chisquare test, P < 0.05). Routine laboratory tests were ordered at midnight from August 1631, 2011 on one medicine floor. All 6 AM and midnight orders of complete blood cell counts and basic/comprehensive metabolic panels on the study floor were analyzed. 538 laboratory tests were ordered at 6 AM from August 115 (preintervention period). 436 Four hundred and thirtysix (79.2%) laboratory tests were ordered at midnight and 112 (20.8%) were ordered at 6 AM from August 1631 (intervention period). The average available time for laboratory results was 5:52 AM (S.D. 136 minutes) for midnight labs and 8:56 AM (SD = 99 minutes) for morning labs. A house staff survey was conducted after the study period. All house staff physicians (N = 6) reported that midnight blood draws improved efficiency, quality of care delivery, and supported changing morning blood draws to midnight. Additional positive feedback was reported from nursing and laboratory department staff. Based on these early promising results, we have expanded this approach to 5 five medical/surgical floors. Preliminary reports again revealed positive feedback from house staff as well as nursing and laboratory department staff.
Midnight routine blood draws can potentially enhance clinical decision making and increase efficiency of patient care without a negative impact on patient satisfaction. Additionally, implementation of midnight blood draws could balance the workload for laboratory and nursing staff. Conventional practices in medicine such as routine morning blood draws are not necessarily logical, evidencebased, or patientcentered. Reevaluation of such routine practices in healthcare delivery is warranted.
To cite this abstract:Patterson A, Sorita A, Lee C, Fischer C, Huang D, Sivaprasad L, Landazuri P, DeLin S. Assessment of Timely Test Results and Impact on Patient Satisfaction Utilizing Routine Midnight Blood Draws As Opposed to Daily Am Blood Draws in an Urban Teaching Hospital. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97716. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/assessment-of-timely-test-results-and-impact-on-patient-satisfaction-utilizing-routine-midnight-blood-draws-as-opposed-to-daily-am-blood-draws-in-an-urban-teaching-hospital/. Accessed May 23, 2019.