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Archives of Pathology & Laboratory... Jun 2022Laboratory directors are tasked with staffing laboratories in a manner that provides adequate services and maintains economic sustainability.
CONTEXT.—
Laboratory directors are tasked with staffing laboratories in a manner that provides adequate services and maintains economic sustainability.
OBJECTIVE.—
To determine the national normative rates of phlebotomy staffing and the types of laboratory operational characteristics that may be associated with the magnitude of those staffing levels.
DESIGN.—
Study participants provided data on inpatient and outpatient phlebotomy sites, including the numbers of patients receiving phlebotomy services, phlebotomy staff, and billable tests. From these data, we calculated performance indicators including the numbers of phlebotomies/phlebotomy full-time equivalent staff, outpatient phlebotomy visits/full-time equivalent staff, and average outpatient phlebotomy wait times. Participants also completed a survey of their laboratory phlebotomy practices.
RESULTS.—
This study was conducted during the third quarter of 2017. Forty-two institutions participated in this study, providing eligible results for 40 selected inpatient sites and 70 selected outpatient sites. The ratios for all performance indicators spanned between 3.3- and 142-fold. The median average outpatient phlebotomy wait time was 8 minutes. None of the performance indicators were associated with the practice variables that we chose to test.
CONCLUSIONS.—
The distribution of phlebotomy staffing performance indicators among the laboratories participating in this study varied widely, even among those groups performing similar volumes of tests.
Topics: Humans; Laboratories; Phlebotomy; Surveys and Questionnaires; Workforce
PubMed: 34784416
DOI: 10.5858/arpa.2021-0158-CP -
Journal of Perioperative Practice Oct 2018
Topics: Bloodletting; History, 18th Century; History, 19th Century; History, Ancient; Humans; Phlebotomy; Therapeutics
PubMed: 30035688
DOI: 10.1177/1750458918790182 -
Biochemia Medica 2016The evidence-based paradigm has changed and evolved medical practice. Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the... (Review)
Review
The evidence-based paradigm has changed and evolved medical practice. Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the evolution of medicine becoming a fundamental diagnostic tool. Nowadays it connects the patient with the clinical laboratory dimension building up a bridge. However, more often there is a gap between laboratory and phlebotomist that causes misunderstandings and burdens on patient safety. Therefore, the scope of this review is delivering a view of modern phlebotomy to "bridge" patient and laboratory. In this regard the paper describes devices, tools and procedures in the light of the most recent scientific findings, also discussing their impact on both quality of blood testing and patient safety. It also addresses the issues concerning medical aspect of venipuncture, like the practical approach to the superficial veins anatomy, as well as the management of the patient's compliance with the blood draw. Thereby, the clinical, technical and practical issues are treated with the same relevance throughout the entire paper.
Topics: Diagnostic Errors; Forearm; Hematology; Humans; Laboratories; Patient Safety; Phlebotomy; Quality Control; Veins
PubMed: 26981016
DOI: 10.11613/BM.2016.002 -
Rinsho Byori. the Japanese Journal of... Oct 2005In 2004, the Japanese Committee of Clinical Laboratory Standards (JCCLS) published a standard phlebotomy guideline, which not only ensures the safety of the patients and... (Review)
Review
In 2004, the Japanese Committee of Clinical Laboratory Standards (JCCLS) published a standard phlebotomy guideline, which not only ensures the safety of the patients and phlebotomists but is adopted to the healthcare setting in Japan. This phlebotomy standard is also essential for the standardization of clinical laboratory tests. This guideline was completed on the basis of current phlebotomy procedures widely in use in Japan using phlebotomy standards in the USA as references, while reconsidering their scientific reasoning as far as possible. At the same time, factors such as practicality and cost benefit were taken into account. The content of the guideline includes necessary facilities and equipment, a step by step safe but practical venipuncture procedure, an explanation of the individual steps, and other supplementary information such as alternative methods. The first edition, published as tentative guideline, is planned to be revised after a set period of time based on the comments and suggestions from a wide range of people concerned, so that it can be published as an approved guideline.
Topics: Clinical Laboratory Techniques; Cost-Benefit Analysis; Humans; Informed Consent; Japan; Pathology, Clinical; Phlebotomy; Practice Guidelines as Topic; Societies, Medical
PubMed: 16296337
DOI: No ID Found -
Biochemia Medica Feb 2017Phlebotomy is often addressed as a crucial process in the pre-analytical phase, in which a large part of laboratory errors take place, but to date there is not yet a... (Review)
Review
Phlebotomy is often addressed as a crucial process in the pre-analytical phase, in which a large part of laboratory errors take place, but to date there is not yet a consolidated methodological paradigm. Seeking literature, we found 36 suitable investigations issued between 1996 and 2016 (April) dealing with the investigation of pre-analytical factors related to phlebotomy. We found that the largest part of studies had a cohort of healthy volunteers (22/36) or outpatients (11/36), with the former group showing a significantly smaller median sample size (N = 20, IQR: 17.5-30 and N = 88, IQR: 54.5-220.5 respectively, P < 0.001). Moreover, the largest part investigated one pre-analytical factor (26/36) and regarded more than one laboratory test (29/36), and authors preferably used paired Student's t-test (17/36) or Wilcoxon's test (11/36), but calibration (i.e. sample size calculation for a detectable effect) was addressed only in one manuscript. The Bland-Altman plot was often the preferred method used to estimate bias (12/36), as well as the Passing-Bablok regression for agreement (8/36). However, often papers did assess neither bias (12/36) nor agreement (24/36). Clinical significance of bias was preferably assessed comparing to a database value (16/36), and it resulted uncorrelated with the size of the effect produced by the factor (P = 0.142). However, the median effect size (ES) resulted significantly larger if the associated factor was clinically significant instead of non-significant (ES = 1.140, IQR: 0.815-1.700 and ES = 0.349, IQR: 0.228-0.531 respectively, P < 0.001). On these evidences, we discussed some recommendations for improving methodological consistency, delivering reliable results, as well as ensuring accessibility to practical evidences.
Topics: Clinical Laboratory Techniques; Diagnostic Errors; Humans; Pathology, Clinical; Phlebotomy; Practice Guidelines as Topic; Quality Assurance, Health Care; Quality Control
PubMed: 28392739
DOI: 10.11613/BM.2017.020 -
Pediatric Pathology & Laboratory... 1996
Topics: Child; Child, Preschool; Humans; Phlebotomy
PubMed: 9025868
DOI: 10.1080/15513819609169296 -
Clinical Laboratory 2006Laboratory testing is an integral part of the decision-making process, and results of laboratory testing often strongly influence medical diagnoses and therapies. There... (Review)
Review
Laboratory testing is an integral part of the decision-making process, and results of laboratory testing often strongly influence medical diagnoses and therapies. There is a long history of quality requirements in laboratory medicine, which have mainly concerned the analytic phase of this process. Owing to the substantial advances in technology, laboratory automation and analytic quality, there is increasing evidence that further quality improvements should be targeted to extra-analytic phases of laboratory testing. Objective difficulties to monitor most of the preanalytic variables which lie outside the direct control or supervision of the laboratory personnel, such as phlebotomy, call for effective educational and preventive policies. Owing to high personnel turnover rates, lack of understanding about good laboratory practices, and inadequate training, there are several opportunities for making errors during phlebotomy, which mainly concern patient misidentification and collection of unsuitable specimens for testing due to unsuited venous accesses, venous stasis, inappropriate collection devices and containers. Improved standardization of phlebotomy techniques, along with operative guidelines dissemination, continuous education, certification, and training of health care professionals involved in blood drawing responsibilities would enhance the chance of obtaining specimens of consistent quality, with favorable revenues for the health care system and the patient's outcome.
Topics: Bloodletting; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; History, Medieval; Humans; Medical Errors; Medical Laboratory Personnel; Patient Identification Systems; Phlebotomy; Quality Control
PubMed: 16812947
DOI: No ID Found -
Journal of Infusion Nursing : the... 2010In the United States, phlebotomies are most often performed for reinfusion of blood to a designated or nondesignated recipient at a later time. These are known,... (Review)
Review
In the United States, phlebotomies are most often performed for reinfusion of blood to a designated or nondesignated recipient at a later time. These are known, respectively, as autologous or allogenic donations. For a few rare blood disorders, however, phlebotomy is performed as a medical intervention for disease management. These are referred to as therapeutic phlebotomies. Four classifications of blood disorders are discussed here for which symptoms and complications can be managed by the use of therapeutic phlebotomy. The article also offers considerations for setting up a therapeutic phlebotomy program.
Topics: Bloodletting; Hematologic Diseases; Hemochromatosis; History, 17th Century; History, 18th Century; History, Ancient; Humans; Phlebotomy; Polycythemia; Porphyrias
PubMed: 20228645
DOI: 10.1097/NAN.0b013e3181d00010 -
Current Opinion in Hematology Mar 2023Development of hepcidin therapeutics has been a ground-breaking discovery in restoring iron homeostasis in several haematological disorders. The hepcidin mimetic,... (Review)
Review
PURPOSE OF REVIEW
Development of hepcidin therapeutics has been a ground-breaking discovery in restoring iron homeostasis in several haematological disorders. The hepcidin mimetic, rusfertide, is in late-stage clinical development for treating polycythemia vera patients with a global phase 3 trial [NCT05210790] currently underway. Rusfertide serves as the first possible noncytoreductive therapeutic option to maintain haematocrit control and avoid phlebotomy in polycythemia vera patients. In this comprehensive review, we discuss the pathobiology of dysregulated iron metabolism in polycythemia vera, provide the rationale for targeting the hepcidin-ferroportin axis and elaborate on the preclinical and clinical trial evidence supporting the role of hepcidin mimetics in polycythemia vera.
RECENT FINDINGS
Recently, updated results from two phase 2 clinical trials [NCT04057040 & NCT04767802] of rusfertide (PTG300) demonstrate that the drug is highly effective in eliminating the need for therapeutic phlebotomies, normalizing haematological parameters, repleting iron stores and relieving constitutional symptoms in patients with polycythemia vera. In light of these findings, additional hepcidin mimetic agents are also being evaluated in polycythemia vera patients.
SUMMARY
Hepcidin agonists essentially serve as a 'chemical phlebotomy' and are poised to vastly improve the quality of life for phlebotomy requiring polycythemia vera patients.
Topics: Humans; Polycythemia Vera; Polycythemia; Hepcidins; Quality of Life; Iron Deficiencies; Phlebotomy; Iron
PubMed: 36728649
DOI: 10.1097/MOH.0000000000000747 -
Clinical Chemistry May 2016
Topics: Humans; Phlebotomy
PubMed: 27127247
DOI: 10.1373/clinchem.2016.256867