What a difference an hour makes. For patients waiting to be discharged or needing a change in treatment, the 60 minutes between 7 and 8 a.m. mean less waiting now at Duke Health Raleigh Hospital (DHRH).

Last year a Physician Satisfaction Team at the hospital identified a need to have early morning lab results on patient charts by 7 a.m. instead of 8 a.m. Having the results up an hour earlier meant that doctors would have more current information to make decisions during their early morning rounds.

And patients anxiously awaiting discharge or needing adjustments to medications or diets would no longer have to wait until non-hospital-based doctors could return later in the day. “The greatest benefit resulting from this improvement has been for patients,” said Meg Garland, clinical operations director for the Medical/Surgical unit at DHRH. “When a lab result indicates a need for a change in treatment, the doctor is able to correct it while making those early morning rounds. It really has just speeded things up for those decisions.”

Changing People’s Mindset
The Physician Satisfaction Team, like Patient Satisfaction and Customer Satisfaction teams, exist as part of the Balanced Scorecard System, to help identify obstacles to physicians’ ability to do their jobs well and identify opportunities for improving systems.

In this case the team, working with a lab representative, identified having lab results posted to patients’ charts earlier as a major area for improvement, according to Sharon Brodie, operations director, DUHS Clinical Laboratories at DHRH. Once the need was identified, the Lab staff made it a departmental goal to have results up by 7 a.m. 98 percent of the time, Then they systematically worked through barriers to achieving that goal.

“Accomplishing this goal meant changing people’s mindset,” Brodie said. “We had to change the mindset of the lab staff on how to prioritize work. Other priority work included same-day surgery patients and emergency department patients. We had to make this a priority, too.”

It took about six months to work through barriers and achieve the desired 98 percent success rate. “We had to change the mindset of hospitalists, too,” Brodie explained. “We were able to get hospital-based doctors to change their patterns of ordering results so that fewer were ordered in the early morning, competing against priority lab work.”

Brodie said the whole lab took the challenge seriously. “This was very much a team effort,” she said.

While improved patient care was the best outcome of the improvement process, the challenge also improved relations between nursing staff and lab staff. “It’s been nice for lab and nursing to work together,” says Garland. “Anytime we’re working on something that leads to improvement together, this builds better relationships.”