1. A Quality Improvement Project
Decreasing Time Delay in Laboratory Coagulation Test Results After Cardiopulmonary Bypass at UCH
A Quality Improvement Project
June 6, 2016
Antasia Giebler CA1, Benjamin Lippert CA2, Nathaniel Brown CA3
Faculty Mentors: Leslie Jameson MD, Holger Eltzschig MD, PhD
Thanks also to Barbara Wilkey, MD

2. Introduction
After cardiopulmonary bypass (CPB), patients can be coagulopathic to varying degrees
CPB is a potent stimulator of inflammatory cascades, which can exacerbate coagulopathies
These coagulopathies often require treatment to control bleeding and ensure a safe transition from surgery to the CTICU

3. Introduction Routine labs drawn post-CPB:
ABG and TEG are processed in the OR lab and reliably return results within 15 mins
CBC, PT/INR, PTT, and Fibrinogen are sent STAT to the main lab for analysis with results taking ~60-90 minutes???
Bleeding is thus treated clinically (and with TEG as it develops) without the aid of coagulation studies, in this precarious post-CPB stage

4. Introduction Benefits of faster accessibility of coagulation values:
Guide which products and drugs are given (i.e. cryoprecipitate vs factor concentrates for bleeding refractory to other interventions)
Possibly reduce overall blood products transfused
Decrease post-CPB bleeding, and enhance patient recovery times
Reduce hospital costs (i.e. less blood products transfused, fewer duplicate lab studies, shorter ICU and/or hospital stays etc)

5. OBJECTIVES Objectives:
Quantify time from blood draw to results available in Epic
Assess lab priority of intraoperative post-CPB studies
Identify specific time delays (e.g. getting to the lab, lab processing time, etc.)
Improve hospital efficiency
Enhance patient care

6. Methods Time blood was drawn was recorded
Data initially collected on 17 pts

7. Initial discoveries
Epic does not, by default, time stamp lab results when the data are uploaded. Default is to display timestamp from when lab label was printed
Verified that Epic itself cannot retrieve this data
Data to come from Beaker, the lab’s software

9. Travel Time

10. Tube station
The average time is a little over 8 minutes, NOT including time spent “waiting in line”
The main OR tube station has the lowest priority (out of 9 priority levels)

11. Lab processing time
Once the sample reaches the lab it is time stamped.
It is again time stamped when the results are released.
(These time stamps are NOT available in EPIC.)

12. Average lab processing times
Difficulty in getting lab processing time
Waiting on the lab to get back to us on the data of the 17 cases we submitted

13. PDSA — first cycle
We planned out our problem and identified several possible points of delay
Attended a lab meeting discussing perceived delays in these cases (dovetailed with an attending pursuing the same goal)
The first cycle identified delays in tubing the samples. These delays are being addressed with tube station priority to be upgraded by the end of this month

14. PDSA — next cycle
The next cycle will involve observations of the samples from collection to the tube station to see, on average, how many handoffs are encountered
Further cycle will include observation of lab sequence once samples arrive
Long term solutions might include expanding POC testing in the STAT lab