Three alternative structural configurations for phlebotomy: A comparison of effectiveness and efficiency.

摘要

In recent years hospitals have utilized many methods to improve the efficiency and quality of their services. In an effort to improve patient satisfaction by reducing delays and the number of health professionals encountered during a hospital stay, some hospitals have implemented a patient-focused care model which includes decentralizing inpatient phlebotomy services.;A prospective correlational design was used to compare the effectiveness and efficiency of three alternative structural configurations of inpatient blood collection: centralized, hybrid and decentralized. A random sample of laboratories across the United States was selected from a purchased data subscription. Laboratory managers were asked to complete an organizational survey and collect data on inpatient blood specimens during a 30-day data collection period.;Effectiveness of the blood collection process was measured by the percentage of specimens rejected during the data collection period. Results from the analysis of variance showed a statistically significant difference in the percentage of specimens rejected for the three phlebotomy configurations: centralized, hybrid, and decentralized [F (2, 28) = 4.27, p = .02] with an effect size of .23. Post-hoc comparison using Tukey's HSD indicated that the mean percentage of specimens rejected for centralized phlebotomy (M = .045, SD = 0.36) was significantly different from the decentralized configuration (M = 1.42, SD = 0.92, p = .03).;The relative efficiency as measured by DEA was not found to vary significantly among the three phlebotomy configurations [F (2, 11) = 1.672, p = .23] after controlling for average daily census. These results should be interpreted with caution due to the small sample size and unequal groups.;Results from this study support the hypothesis that there is a significant difference in the percentage of specimens rejected (effectiveness) for decentralized versus centralized inpatient phlebotomy services. The centralized phlebotomy configuration was found to be more effective when compared to the decentralized configuration. Laboratories in the study which utilized alternative phlebotomy configurations did not demonstrate equivalent performance and therefore are not equifinal.;In addition to phlebotomy configuration, the current study found that facilities that provide on the job training for specimen collectors have a lower percentage of specimens rejected.