Reducing LWBS With a Phlebotomist Based in the Emergency Department

August 26, 2019

Written by Clay Smith

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Using an ED phlebotomist to initiate lab draws in patients with wait times over 20 minutes cut the number of patients who leave before treatment completion (LBTC) in half.

Why does this matter?
LBTC is a measure of all patient who leave the ED early. This may be dangerous for patients, tarnish the hospital’s reputation, and cause lost revenue. Approximately 2/3 of LBTC patients leave without being seen (LWBS), a CMS quality metric with a target of <2%. Does utilization of an ED phlebotomist to obtain necessary labs while patients are waiting reduce the LBTC rate?

Holding their blood samples hostage
This was a retrospective review of 71,942 ED visits. Overall LBTC rate was 5.3%. Visits with door-to-room (DtR) time >20 minutes who had orders for labs were included (just over 17,000 patients). For patients who got labs drawn while waiting, the LBTC rate was 2.7%. For those who had labs ordered but were not drawn by the ED phlebotomist, LBTC rate was 5.3%. In other words, using an ED phlebotomist to initiate lab draws in patients with wait times over 20 minutes cut the LBTC rate in half. This effect was more pronounced as wait times increased well beyond 20 minutes. For those involved in ED operations who are trying to reduce LWBS or LBTC rates, this may be a good option to consider.

Source
Impact of Emergency Department Phlebotomists on Left-Before-Treatment-Completion Rates. West J Emerg Med. 2019 Jul;20(4):681-687. doi: 10.5811/westjem.2019.5.41736. Epub 2019 Jul 2.

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Reviewed by Thomas Davis