A-189 Volume Matters: Continuous Improvement to Reduce Blood Collection Volumes and Collection Tube Utilization
Authors: Hain E A , Hendrix B K , Stelpflug A J , Elliott E A , Boedecker S A , Faber T L , Block D R , Baumann N A 
Published: September 2023

Abstract

Background
Clinical laboratories are constantly changing with automated analyzers and total lab automation (TLA) implemented and replaced over time. Some benefits of newer technologies include decreased specimen volume requirements, less need for repeat testing, and greater throughput. Recent implementation of new analyzers and replacement of TLA in the Central Clinical Laboratory (CCL) at Mayo Clinic, Rochester, MN, prompted the laboratory to reassess blood collection volumes for commonly ordered tests.

Objectives
The aim of this study was to evaluate whether updating the blood collection volumes for clinical chemistry and immunoassay tests performed in the CCL could reduce the volume of blood collected from patients and the number of blood collection tubes utilized.

Methods
Nearly 100 different serum assays from the CCL test menu were reviewed including the basic and comprehensive metabolic, hepatic function, renal function, electrolyte, and lipid panels as well as thyroid function tests, enzymes, hormones, electrolytes, and iron status tests. Cortisol, ferritin, folate, and Vitamin B12 testing were performed on the Beckman DxI800; all other testing was on Roche Diagnostics Cobas 8000 chemistry (ISE, c701, c502) and immunoassay (e801) analyzers. Updated blood volumes for each assay were calculated utilizing manufacturer’s analytical volumes and “dead volume” requirements. Baseline data retrieved from the laboratory information system (LIS) included blood collection volumes and number of tubes collected for 128 patients with physician-orders for laboratory testing on 5/2/21. The collection logic was then updated in the test LIS environment using the new blood volumes requirements and applied to the same 128 orders. Blood volumes and number of tubes collected per order were compared before and after the volume updates.

Results
Baseline data from 128 unique orders showed that 414 total tubes were collected with a median(range) of 3 (2–6) tubes per order and 5 (1–18) tests per tube. The total volume of blood requested at baseline was 2065 mL. Post-intervention, 197 tubes were needed with a median(range) of 2 (1–3) tubes per order and 13 (1–30) tests per tube. The total volume of blood requested after updating volumes was 851 mL.

Conclusions
The practice of reviewing and updating specimen volume requirements when replacing or implementing new analyzers or TLA can greatly reduce the volume of blood collected from patients and the number of blood collection tubes per order. In this study of 128 physician orders for common laboratory tests, updating blood collection information in the LIS reduced the requested blood collection volumes by 59% and decreased the number of blood collection tubes required by 52%. This not only benefits patients because less blood is collected but also conserves blood collection tubes and reduces supply chain demands. Additionally, fewer tubes on the TLA system has the potential to improve throughput and test turnaround time.