QUALITY IMPROVEMENT: Systems engineering case study: Improving patient safety and system productivity by reducing lead-times for blood tests.

Local case reports highlighted safety issues arising from the delays for inpatient blood tests. A multidisciplinary team used systems engineering techniques to understand the dynamics of the end-to-end process and how policies, which benefited the efficiency of individuals and departments, compromised the safety and effectiveness of the whole hospital system. Upstream services were synchronised so that samples arrived in the lab earlier in the day. The laboratory process was then redesigned to meet the variations in hourly workload. Average laboratory lead-times for inpatients reduced from 1 h 58 min to 1 h 29 min with less variation predictability of lead-times. Most results were available by 10.30am rather than 12.00pm and clinical decisions were based on test. Removing the batching and prioritisation policies did not compromise the service for accident and emergency, general practice or outpatient and freed resources to address further delays up and downstream.