Laboratory triaging using CD4 cohort labelling improves sample collection and turnaround time of routine CD4 tests

Dr. Kenneth Batsikana, Dr. Patrick Musinguzi
Thursday, July 24, 2014
Context: What was the issue or process affected? What was the root cause of the challenge?: 

Clients were bled for CD4 tests after being attended to by, and obtaining CD4 laboratory requests, from clinicians.  This meant that clients seen by clinicians late in the afternoon who were due for CD4 testing would have their blood samples taken to the laboratory rather late in the evening.  This resulted in laboratory teams remaining at the healthcare facility to run the tests late in the evening or even the next day. Laboratory staff were constantly stressed and exhausted by end of each day, compromising quality of care for clients.

What Happened: How was the challenge or gap addressed or improved?: 

The teams (both laboratory and ART clinic) met and agreed that 90% of samples for routine CD4 tests should reach the laboratory by 3:00 pm each day.

The ART clinic team also started labeling client files according to their ART cohorts (or enrolment cohorts for pre-ART patients) for quick identification of those due for CD4 tests. The laboratory team member responsible for phlebotomy on a particular day conducts laboratory triaging, identifies clients due for tests and collects samples for analyses. By the time the client sees the clinician, their samples are being processed in the laboratory, effectively reducing time spent in the clinic as well as turnaround time for results.

Nugget: What is the lesson for others?: 

Label client files according to their CD4/ART cohorts for easy and quick identification of clients who are due for CD4 tests in a particular month. Obtain client samples for CD4 tests and submit to the laboratory for processing before the client sees a clinician.

Impact: What are the results of applying the nugget?: 
  • 90% of patients who are due for CD4 tests are easily and quickly identified
  • Samples for routine tests are submitted to the laboratory by 3:00pm, and results are released by end of the same day and are ready for filing the next day
Implementation: What steps are needed to apply the lesson?: 

Organize and conduct a meeting with the service provider team (clinicians, laboratory and data staff, volunteers/ expert clients etc.) to accomplish the following:

  • Identify staff (volunteers) to label patient files following patient care and ART enrolment cohorts. Assign each volunteer a number of files to label. Involve data staff in labeling files at enrolment into care.
  • Agree and set the time clients’ blood samples should reach the laboratory.
  • Select triage teams to identify and write laboratory requests daily for clients. This involves delegation of the duty of writing laboratory requests (on behalf of clinicians) to other staff cadres—including nurses, counselors, or data personnel.
  • Select a phlebotomist who takes blood samples and regularly delivers them to the laboratory.
Action: Who is this for? Where does this nugget to go next?: 

Clinic integrated triage teams, including the phlebotomists, volunteers, nurses, counselors, laboratory teams and clinicians

Dr. Kenneth Batsikana, In-charge ART clinic, Mubende Regional Referral Hospital, Dr. Patrick Musinguzi, Clinical Care Coordinator, Mubende RRH,
Sample of labeled file