A-198 Reducing Specimen Rejections in Ambulatory Care Clinics to Improve Patient Safety and Efficiency

Abstract Background Specimen errors can significantly impact patient safety and operational efficiency leading to delays in test results, diagnosis, and treatment, as well as unnecessary repeat lab draws. In July 2022, the nursing lab services team (LST) noted an average baseline specimen rejection rate of 0.71% for Quest Diagnostics (QD). Although this falls within the national benchmark of 0.60%-0.80% for QD, an initiative began to further reduce the specimen rejection rate. The LST conducted a literature review that identified essential practices for reducing specimen rejection rates. The review highlighted the importance of proper blood collection techniques and ongoing staff training (Gupta et al., 2021). In alignment with this, Chavan et al. (2019) emphasized the need for continuous training and regular assessments for minimizing specimen errors. Additionally, targeted training focused on the blood collection process—such as selecting the appropriate specimen tubes, choosing between straight and butterfly needles, following the correct order of draw, and consulting the test directory—proved to effectively decrease specimen errors (Ahmed et al., 2022). This quality improvement project was performed to reduce the specimen rejection rate and improve patient safety and process efficiency. SMART Aim: To reduce the specimen rejection rate to = 0.60% as evidenced by quarterly reports by end of FY24 Methods In July 2022, the LST nursing team collected and analyzed baseline data from QD test not performed (TNP) monthly reports. Issues identified included unacceptable specimens, insufficient quantity, mislabeled/unlabeled specimens, hemolysis, and clotted specimens. Changes were implemented in collaboration with QD and data intelligence analytic teams beginning August 2022 to decrease specimen rejection rate:Distributed monthly TNP reports to leadership teams for visibility and communication with their respective teamsIncreased site visits to monitor compliance and provide support as neededIdentified and updated filter errorsImplemented new process for obtaining accurate dataIdentified clinics with high specimen rejection rate and total lab errors for department-focused training/educationReviewed monthly score cards at operations leadership meetings and preceptor meetings for visibility and awarenessEstablished education program as part of new employee competency skills labEstablished ongoing education program as part of annual competency skills lab Results Beginning July 2022, the average baseline specimen rejection rate was 0.71% (809,395 total orders with 5,738 errors). In July 2023, the average rejection rate decreased to 0.49% (984,662 total orders with 4,770 errors). Quarterly data revealed average rejection rate:Jul-Sept 2022 (Q1) - 0.56%Oct-Dec 2022 (Q2) - 0.47%Jan-Mar 2023 (Q3) - 0.49%April-June 2023 (Q4) - 0.43% Conclusion Goal of <0.6% was met as evidenced by quarterly reports. Improvement was noted in blood collection compliance, specimen errors, and lab incident reports. Future work will focus on electronic data extraction for automated reporting and dashboard availability. This project can be implemented in any ambulatory care clinic performing specimen collection.