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New Process for Blood Draws Paying Off

It's rare to find a patient who enjoys having blood drawn. Yet it's an experience most patients have to face. Approximately 70 percent of healthcare decisions rely on some component of lab testing, much of which depends on the work of phlebotomists.

These trained specialists face a tough challenge: how to ensure that patients are satisfied with a service many would rather avoid.

Focusing on Patient Satisfaction

That question is important not only to Cedars-Sinai but also to the federal government. The Centers for Medicare and Medicaid Services regularly asks patients to rate their satisfaction with the care they received while in the hospital. Patients fill out surveys that include queries about the quality of hospital-based blood collection.

The answers to these questions bear directly on the work of Laboratory Support Services, which is responsible for about half of all blood drawn at Cedars-Sinai, said associate director Khalil Huballa.

Huballa’s department has sought to better understand patients’ experiences to improve the service its phlebotomists provide. The department decided about two years ago to take a deeper look at its interactions with patients and developed a lab-specific patient questionnaire.

"We came up with our own process that we wanted to participate in ourselves to monitor and see how we're doing," Huballa said.

The effort is paying off.

Before the initiative began, Laboratory Support Services received about 10 Standing Ovations from patients per month. Today, that number is closer to 50.

"We also have had about five of our phlebotomists receive the Circle of Friends recognition, wherein patients donate a gift to the medical center on behalf of that employee because of the services provided," Huballa said.

Identifying Shortfalls

The first step to improving patient care was identifying where the department was falling short. The department randomly selected patients to complete its questionnaire. Patients could give one of five responses that ranged from "poor" to "fabulous" when asked about their experience with phlebotomists.

"We wanted to gauge that patient's experience from the perspective of the process," Huballa said. “We could then take that and make a scale out of it and graph it, so we can see how it was trending for us."

Gaining Patient Feedback With Rounding

Once patients filled out the survey, they were visited by technical managers, team leads from Laboratory Support Services and sometimes staff from Quality Assurance. Rounding is ideally conducted within a few hours of the phlebotomist's visit so that the patient is most likely to recall the experience. Staff often solicited additional feedback from family members who were in the room during a blood draw.

"They all seemed to appreciate it," said Arlette Labostrie, a technical manager with Laboratory Support Services. "We found that when we said we were from the department, and the person who drew your blood this morning reports to me … they could see a direct link that we were aware. I honestly wish we had more time to do this type of work, because the patients seem to appreciate the fact that somebody cares."

Identifying Trends

Once the rounding got underway and survey results were tallied, two common complaints emerged. Patients said phlebotomists often failed to properly explain what they were doing and what to expect while having blood drawn. Patients also said phlebotomists sometimes did a poor job of listening.

"Sometimes our phlebotomists seem to be in a hurry," Labostrie said, noting that staff can feel pressure to complete a certain number of blood draws within an hour. That sense of urgency can lead to rushing and prevent phlebotomists from taking the time to clearly explain to patients what they're doing and why, Labostrie added.

Focus on Communication

Huballa said the department built a targeted approach to improve staff communication skills.

Phlebotomists said they needed more support to respectfully handle patients who seemed to question their expertise. It is not uncommon, for example, for patients to insist their blood be drawn from a particular arm. That can present challenges for trained phlebotomists who may identify the other arm as the best candidate for a good blood draw.

Alicia Santos, a technical manager with Laboratory Support Services, stressed the importance of phlebotomists hearing patients out.

"I tell them to listen to the patient whether they're right or wrong," Santos said. "If they want you to draw from the right arm, look at it. If you can't find a vein, explain to the patient you want to look at the other arm because you can't find a vein on the one they wanted."

The key, Santos added, is for phlebotomists to show they are listening and paying attention to patients’ needs. "At least work with the patient, even though you may end up drawing blood from the vein you wanted in the first place."

Finally, phlebotomists are instructed to ask patients if they can do anything else for them once the blood draw is completed — for example, asking if patients would like the door to their hospital room opened or closed to make them more comfortable.

"That seems to be very powerful," Labostrie said. "All of us have either been in a hospital or have family members in hospitals, and you know how hard it is. So, if somebody comes in — no matter who they are — and offers to do any little thing for you, I think it's much appreciated."

Service Recovery

As part of the Laboratory Support Services initiative, Huballa said the department also decided to adopt the hospitalwide service recovery practice.

"If for some reason during our patient rounding a patient was not happy with the services the phlebotomist provided, or in the event the patient complained to the nurse … we actually have our technical managers or team leads go and visit with the patient," he said.

Ongoing Training

The quest to continually improve patient satisfaction is an integral part of the department's day-to-day discussions.

According to Huballa, much staff training takes place in the form of huddles, one-on-one meetings between supervisors and phlebotomists, and monthly staff meetings, which always include time dedicated to the topic. Sometimes staff will watch videos or other training materials to keep up on issues that are integral to quality patient care.

"It's sort of constant," Huballa said. "We want them to keep in their mind what it is that they do, and how important that role is in taking care of their patients."