Quality improvement in the coagulation laboratory: Reducing the number of insufficient blood draw specimens for coagulation testing

Abstract

Objectives: To report the efforts of our laboratory to reduce quantitynot- sufficient (QNS) specimens via several methods and to directly measure the effect of expired collection tubes on the amount of blood that can be drawn. Methods: We tracked the number of QNS venous-blood specimens per month received by our coagulation laboratory from March 2008 to December 2012. Interventions involved communications that informed nurses and phlebotomists how to avoid drawing QNS specimens and floor sweeps, in which laboratory staff searched for and removed expired vacuum-based blood-collection tubes (VBCTs) from inpatient hospital floors. Also, we assessed 11 healthy donors to determine the amount of blood that could be drawn into expired VBCTs. Results: During the study period, the rate of QNS specimens dropped from a mean of 0.7% to 0.3%. In expired VBCTs collected from healthy donors, we observed a statistically significant difference in the amount of blood drawn into nonexpired vs expired VBCTs (P