What Should We Do?: Residents adding on new tests

Dear Center for Phlebotomy Education:

We have new residents entering orders and it’s wreaking havoc on us and our patients. In the morning, a CBC is ordered then a few hours later chemistries are ordered. Is it ok to draw an extra gold when we draw the lavender?

Our Response:

Technically, that might be acceptable. Economically, though, it's definitely a bad idea.

From a technical standpoint, drawing an extra tube isn't going to put the patient at risk unless, of course, he/she is already anemic. It's forward-thinking, and may save the patient a stick. By so doing, the availability of test results for anything added on to the original order is greatly reduced. Sounds like a win-win, right? But it isn't.

From an economic standpoint, drawing extra tubes on every patient adds up in a hurry and can be a huge drain on the lab's resources. According to an article in MLO magazine, one facility found only four percent of the extra tubes were ever used for testing. They also discovered the staff was spending more time drawing and processing extra tubes than they were saving by not having to perform a second venipuncture. After calculating the additional costs to draw and manage tubes without orders, the cost of the extra tubes, and their disposal, the facility estimated a cost savings of $200,200 per year by discontinuing the practice.

Of course, performing a venipuncture when no tests have even been ordered would most certainly be against the standard of care. 

A better approach would be every time a new batch of residents show up, they should be versed on lab utilization practices that prevent wasted resources and frustration. This requires constant communication, and strong support from laboratory management, including pathologists.