# Reducing Pending Glycated Hemoglobin (HbA1c) Patient Reports in a Tertiary Care Centre in North India: A Quality Improvement Project

## TL;DR

This study reduced delayed HbA1c reports at a hospital in India by improving lab and sample collection processes over 12 weeks.

## Contribution

A novel quality improvement approach combining workflow analysis and staff coordination to reduce pending HbA1c reports.

## Key findings

- Pending HbA1c reports dropped from 1.69% to 0.19% after process changes.
- Manual data entry and missing patient IDs were key issues addressed in the lab workflow.
- Daily tracking of patients who left without samples improved sample collection efficiency.

## Abstract

Introduction

In early August 2023, several outpatients at All India Institute of Medical Sciences (AIIMS), Raebareli, India, complained that their HbA1c reports were not ready as promised. Some required to give a repeat sample, which caused patient dissatisfaction and increased laboratory workload. The aim of this quality improvement (QI) project was to reduce pending glycated haemoglobin (HbA1c) reports by improving laboratory and sample collection workflows within a 12-week period.

Methods

A team was formed to fix the problem. Process mapping, fishbone analysis and two successive Plan-Do-Study-Act (PDSA) cycles were undertaken over 12 weeks. The first PDSA cycle was in the laboratory, and the second was in the sample collection area. Data was extracted in Microsoft Excel spreadsheet. Data was analysed in Microsoft Excel and GraphPad. Fisher's Exact Test was used to determine if the improvement from this QI project was statistically significant.

Results

Process mapping and fishbone analysis revealed that the barcode scanner of the HbA1c analyser was non-functional, hence the technician manually entered the results in a laboratory register and afterwards entered those in the Hospital Information Management System (HIMS). In PDSA cycle 1, the team noticed that the manual register contained only laboratory ID (unique laboratory identification number) and HbA1c values. The team instructed the laboratory technician to include the patient’s registration number in the manual register, besides the laboratory ID and test value. In PDSA cycle 2, the team observed that after raising a test request, a few patients had departed the collection area without giving a sample. The team advised the nursing officers in the sample collection centre to prepare a list of patients (with their hospital registration number) who had raised the HbA1c test requests, but departed without giving a blood sample, and send this list daily to the laboratory technician after sample collection hours. These interventions reduced the pending HbA1c reports from 1.69% to 0.19% over 12 weeks (p=0.016).

Conclusion

Reduction in pending reports decreased the number of patient complaints and improved the laboratory workflow process. Continuous assessment and documentation of pending work, clarity on tasks needed, and regular staff meetings were essential for this success.