A-174 More Timely Patient Care Amidst Healthcare Staffing Shortages, Reducing Blood Specimen Tube Barcode Errors for Continuous Flow in an Automated Laboratory System
Authors: Copeland J R , Guerriero J , Cook B C 
Published: September 2023

Abstract

Background
The Core Laboratory at Henry Ford Hospital utilizes total laboratory automation to support chemistry, hematology and coagulation analyzers, processing approximately 10 000 specimens daily. Testing and reporting delays can occur when the system encounters a specimen tube barcode error. Specimens will stop moving and causes approximately a 2-minute per error production pause while the error is resolved. This induces congestion for all other specimens in line behind the error. The seemingly trivial minutes of congestion leads to a domino effect, resulting in reduced line productivity, a temporary limit of testing capacity and prolonged TATs. The laboratory receives specimen tubes with labels generated from over 600 printers. The system encounters 200–250 errors daily associated with barcode read failures of various types. Errors account for an estimated loss of ∼320 h of staff productivity per month.

Methods
Automation line error files, manually recorded data from lab staff, observations of automation line errors occurring in real time, data from a printer maintenance blitz and barcode printer service requests were used in root cause analysis. Three progressive Kaizens events were organized in 2022 to induce rapid process change through focused chartering of events and actions. A probing study designed to induce controlled defects and stoppages helped recognize where congestion on the line was occurring. Simulation of barcode application errors allowed an understanding of the impact of label application. Staff and line productivity loss analysis predicted the potential opportunity of error reduction.

Results
Fifty-five percent of the barcode errors were caused by improper label application and 45% were poor print quality of the barcode on the label. Of the label application defects, 55% were caused by the label being placed upside-down, of which 34% were caused by the label format used by our Emergency Department. Print quality issues such as faded or pitted printing labels accounted for 45% of errors. The printer preventive maintenance blitz successfully reduced print quality errors by 30%. Converting to a more robust printer in two high-volume areas resulted in zero print quality errors over three months. Barcode label format changes were 100% effective in eliminating upside-down as a root cause.

Conclusion
Elimination of barcode line errors can recover 2.0 FTEs in three divisions per month, while increasing automation line productivity and a cost approximately$150 000 per year in work delays and unnecessary rework. The Kaizen approach to problem-solving allowed for rapid brainstorming amongst multiple teams. Altered label format allowed built-in engineering control by mistake-proofing the process and making label positioning irrelevant. Identification of areas where high volumes of labels were being printed and replacing those printers with more robust printers reduced service calls and eliminated printer causal factors since these printers require less hands-on maintenance. Finally, instituting preventative label printer maintenance and total quality management reduces or prevents errors associated with print quality. Sustaining mechanisms include continued real-time data documentation and communication of defects, collaboration with colleagues in Nursing for further root cause analysis of barcode application defects.