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Creating a culture of change requires ensuring employees understand how all steps work together toward providing exceptional patient care.
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Maximizing Workflows, Quality, and Outcomes via Nursing–Laboratory Collaboration

Fostering teamwork among front-line lab and nursing staff can significantly improve key metrics, outcomes, and job satisfaction

April Day, MBA, BS, MLS(ASCP)
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April Day, MBA, BS, MLS(ASCP), is the senior director of Clinical Pathology for Geisinger Health System. She oversees clinical operations at eight hospitals and five rapid response laboratories. Day received a Bachelor of Science in biology from Lock Haven University in 2005. She completed a medical laboratory science program through Williamsport Hospital in 2008, as well as an MBA through the University of Scranton.

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Danielle Forker, MSN, RN, CEN, CPEN, CFRN
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Danielle Forker, MSN, RN, CEN, CPEN, CFRN, is the director of nursing for Geisinger Medical Center Muncy and manages nursing personnel and daily operational related activities for the site.

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Published:Oct 25, 2023
|5 min read
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As leaders, we are responsible for identifying opportunities, empowering employees, and inspiring change. Creating a culture of change requires ensuring employees understand how all steps work together toward providing exceptional patient care. When we fail to communicate how individual actions and initiatives support big picture goals, the different departments and disciplines remain siloed and compete against each other instead of working as a team.

Before leaders can steer teams in the correct direction, they must first understand each person's role in the outcomes. Start by gaining a comprehensive understanding of the metrics set for each department by reviewing all the steps and corresponding stakeholders in the process. Follow this with an analysis of how those metrics depend on one another for successful outcomes. 

Once the analysis is complete, leaders can engage their different teams in change management through workflow collaboration with a multidisciplinary workgroup approach. Continuous review of performance improvement measures is important to identify ongoing effectiveness and potential issues that may arise. Success relies on joint accountability for implementation, tracking, and corrective actions or interventions.

The benefits of an interdisciplinary approach

Gather relevant information and metrics

Using an interdisciplinary approach provides you with a comprehensive understanding of everybody’s role and how it pertains to positive patient outcomes. Linking how the goals of each department relate to one another leads to teamwork instead of interdepartmental competition. Teamwork and shared accountability help establish rapport and respect between the teams, ensuring they are more willing to work together to resolve issues and concerns that may arise. 

A team mentality also promotes leveraging shared resources and expertise for training purposes. This is strengthened by continuously managing up and encouraging positive feedback to and from all teams involved.

Understand the limiting factors

At Geisinger, we first saw the benefit of this approach when investigating increased throughput times in the emergency department (ED). 

Initially, the ED and lab teams were siloed, and both were attempting to meet metrics that relied on multiple contributing factors: The ED team thought lab turnaround times were impeding throughput without taking ownership of the steps in the process for which they were accountable for. The lab team was frustrated because they were not meeting expected collection-to-result times when not receiving specimens in a timely manner. 

The frustration felt by both groups led to negative interactions and poor cooperation.

Create a collaborative action plan

Leadership from both teams sat down and took the time to understand both departments’ metrics and obstacles. Our first collaborative effort focused on turnaround times for ED STAT laboratory results. The site was new to our organization, and we began to track the metric as of July 2018. The goal was to complete ED STATs ≥ 75 percent in ≤ 60 mins from order to result. That July the average for the tracked labs was 29.2 percent. Through continued efforts, the lab team was able to improve to an average of 63.1 percent by that November. 

However, the ED technicians that perform collections also contribute to the time from order to collection and collection to receipt. Meetings with ED leadership to review metrics, contributing factors, and education on navigating the laboratory dashboards led to further improvement over the next few months, hitting 72.5 percent by April. 

In May, nursing leadership reviewed in staff meetings and set staff goals around the order-to-collect metric for nursing. The average in June for order-to-result jumped to 87.9 percent with all metrics in range. The improved turnaround time for the STAT labs was directly linked to improved throughput in the ED (Figure 1). Working together, the teams were able to maintain these improvements (Figure 2). 

Graph illustrating the time from arrival to discharge in the emergency department at Geisinger Medical Laboratories.
Figure 1. Emergency department turnaround time in minutes from April 2018 to June 2019. Data Source: Geisinger Medical Laboratories, Quality Plan Quality Calendar FY19-Cy2023.
Geisinger Medical Laboratories, Today's Clinical Lab
Graph illustrating improvement in order to result Geisinger Medical Laboratories.
Figure 2. Order-to-result data from July 2018 to June 2020. Threshold (red) of 75 percent in less than 60 minutes. Data Source: Geisinger Medical Laboratories, Quality Plan Quality Calendar FY19-Cy2023.
Geisinger Medical laboratories, Today's Clinical Lab

Collaboration drives real results

In January 2022, we opened a new facility. When designing the new facility, a team of nurses decided to create communal areas, including break and locker rooms, shared by multiple disciplines to help staff get to know one another and promote comradery. 

Beyond the ED and laboratory, this simple change in layout has resulted in an overall more cohesive workforce. 

Better education and training

Tracking blood culture contamination from both lab collectors and non-lab collectors at the new location showed that collections performed by non-lab staff were above the threshold of 2 percent. 

Joint education on this issue with laboratory and non-lab staff began in November 2022: Phlebotomy provided instruction on proper procedures for collection and competency, and nursing helped facilitate times and forums for instruction. 

This collaborative approach to education and training, including the commitment from nursing to help improve laboratory outcomes, helped keep blood culture contamination rates under threshold (Figure 3). 

Phlebotomy continues to attend ED huddles on a regular basis to provide snippet refresher education and updates to staff to maintain the improvements.

Graph illustrating blood culture contamination rates at Geisinger Medical Laboratories.
Figure 3. Blood culture contamination rates from February 2022 to July 2023. Threshold (red) of 2 percent. Data Source: Geisinger Medical Laboratories, Quality Plan Quality Calendar FY19-Cy2023.
Geisinger Medical Laboratories, Today's Clinical Lab

Improved workflow and operations

In May of this year, front-line laboratory and nursing staff worked together at both facilities to improve workflow and operational efficiency. 

The objective was to have nurses and patient care technicians collect all ED and inpatient labs between 11 p.m. and 6 a.m. Morning labs were moved from 5 a.m. to 6 a.m. to reduce noise and assist with patient satisfaction and the Quiet at Night initiative. Both hospitals had a low volume of lab collections during this overnight period. 

Staff worked together to determine the best workflow for handoff communication and collection monitoring, including what was needed in electronic health records to ensure nursing could monitor lab orders and intended collection times. Lab staff would then cover expanded outpatient hours of operation to improve patient access and accommodate increased volumes. 

This transition improved service times (Figure 4) and led to better employee satisfaction via increasing ED patient care technicians’ competence, skill, and confidence. The teams now also assist one another during busy times in each other’s departments.

Graph illustrating Outpatient Service Time at Geisinger Medical Laboratories.
Figure 4. Outpatient service time from January 2023 to August 2023. Data Source: Geisinger Medical Laboratories, Quality Plan Quality Calendar FY19-Cy2023.
Geisinger Medical Laboratories, Today's Clinical Lab

Working together to improve patient care

Ongoing collaboration plays an important part in our workflow improvements every day. It has improved our ability and efficiency in investigating errors, delays, and patient concerns. The ability of the departments to function together as a team is imperative to success. Working together and respecting each other has improved efficiency, quality, and patient care, as well as job satisfaction.