Date of Conferral

2-17-2025

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

Rabeh Hijazi

Abstract

Preanalytical errors in laboratory testing represent a significant challenge in healthcare delivery, accounting for most laboratory errors. Inadequate and inconsistent phlebotomy training has been identified as a major contributor to high rates of preanalytical errors and specimen rejection in nonprofit acute care hospitals within multihospital health systems in the U.S. Midwest region. The aim of this integrative review was to identify best practices and strategies for improving on-the-job phlebotomy training programs in Midwestern nonprofit acute care hospitals within multihospital health systems, using the Donabedian model as a framework to enhance specimen quality, reduce rejection rates, and increase patient satisfaction. A systematic search of five major healthcare databases (PubMed/MEDLINE, CINAHL, Scopus, Web of Science, and ProQuest Health Management) was conducted for peer-reviewed literature published between 2019 and 2024. Studies (N = 23) were evaluated using Johns Hopkins evidence-based practice appraisal tools, and thematic analysis was performed to identify key patterns and relationships. The analysis revealed that standardized training protocols incorporating evidence-based practices significantly reduced preanalytical error rates (from 2.1% to 1.3%) and demonstrated cost savings of approximately $12,789 per 32,783 samples. Four critical dimensions emerged as essential components of effective phlebotomy training programs: theoretical knowledge acquisition, practical skills development, communication enhancement, and error prevention strategies. The study contributes to positive social change by recommending stakeholders implement standardized phlebotomy training programs that incorporate evidence-based practices, regular competency assessments, and quality indicator monitoring using the Donabedian model.

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