1
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Garner J, Osoria Z, Barker D, Stigaard LC. Escalation process of critical values when these cannot be communicated on first attempt: A hospital-wide process improvement project. Am J Clin Pathol 2024:aqae099. [PMID: 39177003 DOI: 10.1093/ajcp/aqae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/26/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES Since laboratory critical values reflect such an abnormal pathologic state that there is imminent danger to the patient, it is crucial to deliver the result upon initial call with an escalation process when the initial call cannot occur. In our 8-hospital system, one of the hospitals used the escalation procedure twice as frequently compared with the other hospitals. This work presents hospital-wide quality improvement processes that decreased escalation of critical value calls so as to reach the same proportion of escalated calls compared to other hospitals in the system. METHODS The laboratory met weekly with leaders of different hospital areas and quality management; they presented the interventions they implemented, and the laboratory monitored their progress. RESULTS Monitoring and reviewing with providers the importance of critical values decreased temporarily escalated calls from 25% to 18%. Having a dedicated phone to call critical values in each hospital area decreased the calls in a sustained fashion, which now fluctuate between 9% and 14%. Other interventions, including having a dedicated person receiving critical value results, did not decrease escalated critical value calls. CONCLUSIONS Having a dedicated phone in each hospital area that receives the initial critical value call simplifies and standardizes the process.
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Affiliation(s)
- Jeannette Garner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, US
| | - Zully Osoria
- Quality Management for Emory Medical Laboratories, Atlanta, GA, US
| | - Debra Barker
- Emory University Hospital at Midtown, Atlanta, GA, US
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2
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Scott IA. Using information technology to reduce diagnostic error: still a bridge too far? Intern Med J 2022; 52:908-911. [PMID: 35718736 DOI: 10.1111/imj.15804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ian A Scott
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
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3
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Slovis BH, Vervilles WJK, Vawdrey DK, Swartz JL, Winans C, Kairys JC, Riggio JM. Providers Electing to Receive Electronic Result Notifications: Demographics and Motivation. Appl Clin Inform 2022; 13:681-691. [PMID: 35830863 DOI: 10.1055/s-0042-1751092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Automated electronic result notifications can alert health care providers of important clinical results. In contrast to historical notification systems, which were predominantly focused on critical laboratory abnormalities and often not very customizable, modern electronic health records provide capabilities for subscription-based electronic notification. This capability has not been well studied. OBJECTIVES The purpose of this study was to develop an understanding of when and how a provider decides to use a subscription-based electronic notification. Better appreciation for the factors that contribute to selecting such notifications could aid in improving the functionality of these tools. METHODS We performed an 8-month quantitative assessment of 3,291 notifications and a qualitative survey assessment of 73 providers who utilized an elective notification tool in our electronic health record. RESULTS We found that most notifications were requested by attending physicians (∼60%) and from internal medicine specialty (∼25%). Most providers requested only a few notifications while a small minority (nearly 5%) requested 10 or more in the study period. The majority (nearly 30%) of requests were for chemistry laboratories. Survey respondents reported using the tool predominantly for important or time-sensitive laboratories. Overall opinions of the tool were positive (median = 7 out of 10, 95% confidence interval: 6-9), with 40% of eligible respondents reporting the tool improved quality of care. Reported examples included time to result review, monitoring of heparin drips, and reviewing pathology results. CONCLUSION Developing an understanding for when and how providers decide to be notified of clinical results can help aid in the design and improvement of clinical tools, such as improved elective notifications. These tools may lead to reduced time to result review which could in turn improve clinical care quality.
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Affiliation(s)
- Benjamin H Slovis
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.,Office of Clinical Informatics, Jefferson Health, Philadelphia, Pennsylvania, United States
| | - William J K Vervilles
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - David K Vawdrey
- Office of the Chief Data and Informatics Officer, Geisinger Health, Danville, Pennsylvania, United States
| | - Jordan L Swartz
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, New York, United States
| | - Catherine Winans
- Information Services and Technology, Jefferson Health, Philadelphia, Pennsylvania, United States
| | - John C Kairys
- Office of Clinical Informatics, Jefferson Health, Philadelphia, Pennsylvania, United States.,Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Jeffrey M Riggio
- Office of Clinical Informatics, Jefferson Health, Philadelphia, Pennsylvania, United States.,Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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4
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Hughes AEO, Jackups R. Clinical Decision Support for Laboratory Testing. Clin Chem 2021; 68:402-412. [PMID: 34871351 DOI: 10.1093/clinchem/hvab201] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND As technology enables new and increasingly complex laboratory tests, test utilization presents a growing challenge for healthcare systems. Clinical decision support (CDS) refers to digital tools that present providers with clinically relevant information and recommendations, which have been shown to improve test utilization. Nevertheless, individual CDS applications often fail, and implementation remains challenging. CONTENT We review common classes of CDS tools grounded in examples from the literature as well as our own institutional experience. In addition, we present a practical framework and specific recommendations for effective CDS implementation. SUMMARY CDS encompasses a rich set of tools that have the potential to drive significant improvements in laboratory testing, especially with respect to test utilization. Deploying CDS effectively requires thoughtful design and careful maintenance, and structured processes focused on quality improvement and change management play an important role in achieving these goals.
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Affiliation(s)
- Andrew E O Hughes
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ronald Jackups
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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5
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Heneghan M, Westphal K, Bergman L, Falkiner R, Filipova L, Geisler S, Kendrich C, Martinez J, Malone S, Haymond S, Callas D, MacQuarrie KL. Closed loop communication using provider team-specific smartphones improves the critical laboratory value notification process in paediatric inpatients. BMJ Open Qual 2021; 10:bmjoq-2021-001420. [PMID: 34521622 PMCID: PMC8442100 DOI: 10.1136/bmjoq-2021-001420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/28/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mallorie Heneghan
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kathryn Westphal
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lina Bergman
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Robert Falkiner
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Lora Filipova
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Susan Geisler
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Christina Kendrich
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Juanita Martinez
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Shakita Malone
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Shannon Haymond
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Demetra Callas
- Department of Pathology, Northwestern University Feinberg School of Medicine/Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kyle L MacQuarrie
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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6
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Can Çubukçu H, Vanstapel F, Thelen M, Bernabeu-Andreu FA, van Schrojenstein Lantman M, Brugnoni D, Mesko Brguljan P, Milinkovic N, Linko S, Vaubourdolle M, O'Kelly R, Kroupis C, Lohmander M, Šprongl L, Panteghini M, Boursier G. Improving the laboratory result release process in the light of ISO 15189:2012 standard. Clin Chim Acta 2021; 522:167-173. [PMID: 34418364 DOI: 10.1016/j.cca.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
The ISO 15189:2012 standard section 5.9.1 requires laboratories to review results before release, considering quality control, previous results, and clinical information, if any, and to issue documented procedures about it. While laboratory result reporting is generally regarded as part of the post-analytical phase, the result release process requires a general view of the total examination process. Reviewing test results may follow with troubleshooting and test repetition, including reanalyzing an individual sample or resampling. A systematic understanding of the result release may help laboratory professionals carry out appropriate test repetition and ensure the plausibility of laboratory results. In this paper, we addressed the crucial steps in the result release process, including evaluation of sample quality, critical result notification, result reporting, and recommendations for the management of the result release, considering quality control alerts, instrument flags, warning messages, and interference indexes. Error detection tools and plausibility checks mentioned in the present paper can support the daily practice of results release.
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Affiliation(s)
- Hikmet Can Çubukçu
- Ankara University Stem Cell Institute, Interdisciplinary Stem Cells and Regenerative Medicine, Ankara, Turkey.
| | - Florent Vanstapel
- Laboratory Medicine, Department of Public Health, Biomedical Sciences Group, University Hospital Leuven, Belgium, KU Leuven, Leuven, Belgium
| | - Marc Thelen
- Result Laboratory for Clinical Chemistry, Amphia Hospital Breda, the Netherlands,; Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Marith van Schrojenstein Lantman
- Result Laboratory for Clinical Chemistry, Amphia Hospital Breda, the Netherlands,; Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Duilio Brugnoni
- Clinical Chemistry Laboratory, Spedali Civili, Brescia, Italy
| | - Pika Mesko Brguljan
- Department of Clinical Chemistry, University Clinic for Respiratory and Allergic Deseases, Golnik, Slovenia
| | - Neda Milinkovic
- Department of Medical Biochemistry, Pharmaceutical Faculty, University of Belgrade, Belgrade, Serbia
| | | | | | - Ruth O'Kelly
- Association of Clinical Biochemists in Ireland, Ireland
| | - Christos Kroupis
- Department of Clinical Biochemistry, Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens, Haidari, Greece
| | - Maria Lohmander
- Regional Laboratoriemedicin, Sahlgrenska Universitetssjukhuset, Trollhättan/Göteborg, Sweden
| | - Luděk Šprongl
- Clinical Laboratory, Hospital Kladno, Kladno, Czech Republic
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", and Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy
| | - Guilaine Boursier
- Dept of Genetics, Rare Diseases and Personalized Medicine Rare Diseases and Autoinflammatory Unit, CHU Montpellier, Montpellier, France
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7
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Hopkins MR, Butcher MR, Martin KM, Small LR, Sokoll LJ. Quality Improvement in Critical Value Delivery at a Tertiary Care Center. J Appl Lab Med 2021; 6:985-991. [PMID: 33904919 DOI: 10.1093/jalm/jfab002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Prompt notification of critical laboratory values to providers is essential for effective patient care. To improve the delivery of these critical values, a quality improvement project was initiated to determine the obstacles to prompt notification and to identify possible interventions to improve this process. METHODS Critical value call logs were retrieved, and delivery time, patient location, test name, and call time were abstracted and analyzed. All critical values with delivery times greater than 60 min were reviewed by 2 authors for 1 representative month in both the pre- and postintervention period. RESULTS Based on the results of the data review, a modification to the laboratory information system call center color-coded alerts was introduced to address delays attributable to the laboratory. The overall rate of calls greater than 60 min decreased from 3.4% ± 0.8% in the preintervention study period to 1.3 ± 0.3%, postintervention. The average number of values not delivered within 60 min decreased by 64% across all locations, following with an 82% decrease for values originating from inpatient locations, and a 39% decrease for outpatient values. CONCLUSIONS Low complexity interventions to critical value callback protocols can significantly increase the efficacy of communication between the laboratory and providers.
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Affiliation(s)
- Mark R Hopkins
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Monica R Butcher
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin M Martin
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lona R Small
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Lori J Sokoll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Karin A, Kulasingam V, Chartier LB, Ejumudo A, Wolff T, Brinc D. Recurring Critical Results and Their Impact on the Volume of Critical Calls at a Tertiary Care Center. J Appl Lab Med 2021; 6:962-968. [PMID: 33582795 DOI: 10.1093/jalm/jfab001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND When a test result is critically abnormal, laboratories notify the responsible caregivers immediately, usually with a phone call. If the same test was ordered repeatedly, our institution has a policy of not notifying the caregiver if the previous result was also critical and within 24 h. We compared our policy with those of several different laboratories in North America and estimated the impact of changing our current policy to calling for all critical results, regardless of the time interval. METHODS Several North American laboratories (n = 15) were surveyed regarding their critical result notification policy. For our institution, we performed a retrospective analysis focusing on critical values in a 5-month period for common chemistry tests. We estimated the effect on volume of calls and the impact on workload with regard to changing the critical result notification policy and critical thresholds. RESULTS A majority of surveyed laboratories had some form of restriction for calling about recurring critical results. In our institution, removing the restrictions would increase the average number of daily calls by 11%-155%, depending on the analyte. The choice of critical thresholds also has an effect on the number of calls, and the effect depends on the analyte and the threshold chosen. CONCLUSIONS Guidelines do not specify how recurring critical results should be communicated. Depending on the institutional resources, some laboratories call only the first critical result for one or more tests if certain criteria are met. Modification of these policies can lead to significant changes in the volume of calls made by the laboratory and can have numerous impacts related to workload, logistics, and patient care.
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Affiliation(s)
- Amir Karin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Clinical Biochemistry, University Health Network, Toronto, Canada
| | - Lucas B Chartier
- Department of Emergency Medicine, University Health Network, Toronto, Canada
| | - Angela Ejumudo
- Department of Clinical Biochemistry, University Health Network, Toronto, Canada
| | - Talya Wolff
- Department of Clinical Biochemistry, University Health Network, Toronto, Canada
| | - Davor Brinc
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Clinical Biochemistry, University Health Network, Toronto, Canada
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9
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Kavsak PA. The Evidence for Laboratory Test-Based Computer Clinical Decision Support Tools on Medication Errors and Adverse Drug Events. J Appl Lab Med 2019; 3:922-924. [PMID: 31639683 DOI: 10.1373/jalm.2018.028951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/31/2019] [Indexed: 11/06/2022]
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10
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Fei Y, Zhao H, Wang W, He F, Zhong K, Yuan S, Wang Z. National survey on current situation of critical value reporting in 973 laboratories in China. Biochem Med (Zagreb) 2019; 27:030707. [PMID: 29180915 PMCID: PMC5696756 DOI: 10.11613/bm.2017.030707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/30/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction The aim of the study was to investigate the state-of-the-art of the performance of critical value reporting and provide recommendations for laboratories setting critical value reporting time frames. Materials and methods The National Centre for Clinical Laboratories in China initiated a critical value reporting investigation in 2015. A questionnaire related to critical value reporting policy was sent to 1589 clinical laboratories in China online. The questionnaire consisted of a set of questions related to critical value reporting policy and a set of questions related to timeliness of critical value reporting. The survey data were collected between March and April 2015. Results A total survey response rate was 61.2%. The critical value unreported rate, unreported timely rate, and clinical unacknowledged rate of more than half of participants were all 0.0%. More than 75.0% of participants could report half of critical values to clinicians within 20 minutes and could report 90.0% of critical values to clinicians within 25 minutes (from result validation to result communication to the clinician). The median of target critical value reporting time was 15 minutes. “Reporting omission caused by laboratory staff”, “communications equipment failure to connect”, and “uncompleted application form without contact information of clinician” were the three major reasons for unreported critical value. Conclusions The majority of laboratories can report critical values to responsible clinical staff within 25 minutes. Thus, this value could be recommended as suitable critical value reporting time frame for biochemistry laboratories in China. However, careful monitoring of the complete reporting process and improvement of information systems should ensure further improvement of critical value reporting timeliness.
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Affiliation(s)
- Yang Fei
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Haijian Zhao
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Wei Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Falin He
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Kun Zhong
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Shuai Yuan
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
| | - Zhiguo Wang
- National Center for Clinical Laboratories/Beijing Engineering Research Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R. China
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11
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Whitehead NS, Williams L, Meleth S, Kennedy S, Ubaka-Blackmoore N, Kanter M, O'Leary KJ, Classen D, Jackson B, Murphy DR, Nichols J, Stockwell D, Lorey T, Epner P, Taylor J, Graber ML. The Effect of Laboratory Test-Based Clinical Decision Support Tools on Medication Errors and Adverse Drug Events: A Laboratory Medicine Best Practices Systematic Review. J Appl Lab Med 2019; 3:1035-1048. [PMID: 31639695 DOI: 10.1373/jalm.2018.028019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/27/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Laboratory and medication data in electronic health records create opportunities for clinical decision support (CDS) tools to improve medication dosing, laboratory monitoring, and detection of side effects. This systematic review evaluates the effectiveness of such tools in preventing medication-related harm. METHODS We followed the Laboratory Medicine Best Practice (LMBP) initiative's A-6 methodology. Searches of 6 bibliographic databases retrieved 8508 abstracts. Fifteen articles examined the effect of CDS tools on (a) appropriate dose or medication (n = 5), (b) laboratory monitoring (n = 4), (c) compliance with guidelines (n = 2), and (d) adverse drug events (n = 5). We conducted meta-analyses by using random-effects modeling. RESULTS We found moderate and consistent evidence that CDS tools applied at medication ordering or dispensing can increase prescriptions of appropriate medications or dosages [6 results, pooled risk ratio (RR), 1.48; 95% CI, 1.27-1.74]. CDS tools also improve receipt of recommended laboratory monitoring and appropriate treatment in response to abnormal test results (6 results, pooled RR, 1.40; 95% CI, 1.05-1.87). The evidence that CDS tools reduced adverse drug events was inconsistent (5 results, pooled RR, 0.69; 95% CI, 0.46-1.03). CONCLUSIONS The findings support the practice of healthcare systems with the technological capability incorporating test-based CDS tools into their computerized physician ordering systems to (a) identify and flag prescription orders of inappropriate dose or medications at the time of ordering or dispensing and (b) alert providers to missing laboratory tests for medication monitoring or results that warrant a change in treatment. More research is needed to determine the ability of these tools to prevent adverse drug events.
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Affiliation(s)
| | | | | | | | | | - Michael Kanter
- Permanente Federation and Regional Medical Director of Quality and Clinical Analysis, Kaiser Permanente Southern California, Pasadena, CA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Classen
- Pascal Metrics, Washington, DC.,University of Utah School of Medicine, Salt Lake City, UT
| | - Brian Jackson
- University of Utah School of Medicine, Salt Lake City, UT.,ARUP Laboratories, Salt Lake City, UT
| | - Daniel R Murphy
- Houston VA Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.,Department of Medicine, Baylor College of Medicine, Houston, TX
| | - James Nichols
- Vanderbilt University School of Medicine, Nashville, TN
| | - David Stockwell
- Pascal Metrics, Washington, DC.,Division of Critical Care Medicine, Children's National Medical Center, Washington, DC.,Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Thomas Lorey
- TPMG Regional Reference Laboratory, Kaiser Permanente Northern California, Berkeley, CA
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12
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Arbiol-Roca A, Corral-Comesaña S, Cano-Corres R, Castro-Castro MJ, Dastis-Arias M, Dot-Bach D. Analysis of laboratory critical values at a referral Spanish tertiary university hospital. Biochem Med (Zagreb) 2018; 29:010704. [PMID: 30591814 PMCID: PMC6294153 DOI: 10.11613/bm.2019.010704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/20/2018] [Indexed: 11/01/2022] Open
Abstract
Introduction The aim of this study was to analyse critical value data from our laboratory and compare our critical value reporting policy with others in the literature. Materials and methods Analysis of critical values was performed on data obtained over a 6-month period in a tertiary university hospital. Results We identified 5723 critical values, of which approximately 80% came from STAT testing (4577), 15% from routine inpatients testing (884) and 5% from routine outpatients testing (262). The highest proportion of critical values corresponded to oxygen partial pressure (17.7%), followed by potassium ion (17.6%) concentrations. The parameters associated with the highest critical value notification percentage in emergency patients were pH, haematocrit, glucose, potassium ion and haemoglobin concentrations. In inpatients, these parameters were glucose, phosphate, haemoglobin, sodium ion and potassium ion concentrations. In outpatients, they were calcium and potassium concentrations. Conclusions The analysis of critical values in our hospital is in accordance with that reported in the literature. Our findings demonstrate the importance of incorporating improvement actions not only in critical value notification, but especially in the registration of this activity.
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Affiliation(s)
- Ariadna Arbiol-Roca
- Laboratori Clínic, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ruth Cano-Corres
- Clinical Laboratory, Biochemistry Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - María José Castro-Castro
- Laboratori Clínic, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Macarena Dastis-Arias
- Laboratori Clínic, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Dolors Dot-Bach
- Laboratori Clínic, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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13
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Maillet É, Paré G, Currie LM, Raymond L, Ortiz de Guinea A, Trudel MC, Marsan J. Laboratory testing in primary care: A systematic review of health IT impacts. Int J Med Inform 2018; 116:52-69. [PMID: 29887235 DOI: 10.1016/j.ijmedinf.2018.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 05/07/2018] [Accepted: 05/20/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Laboratory testing in primary care is a fundamental process that supports patient management and care. Any breakdown in the process may alter clinical information gathering and decision-making activities and can lead to medical errors and potential adverse outcomes for patients. Various information technologies are being used in primary care with the goal to support the process, maximize patient benefits and reduce medical errors. However, the overall impact of health information technologies on laboratory testing processes has not been evaluated. OBJECTIVES To synthesize the positive and negative impacts resulting from the use of health information technology in each phase of the laboratory 'total testing process' in primary care. METHODS We conducted a systematic review. Databases including Medline, PubMed, CINAHL, Web of Science and Google Scholar were searched. Studies eligible for inclusion reported empirical data on: 1) the use of a specific IT system, 2) the impacts of the systems to support the laboratory testing process, and were conducted in 3) primary care settings (including ambulatory care and primary care offices). Our final sample consisted of 22 empirical studies which were mapped to a framework that outlines the phases of the laboratory total testing process, focusing on phases where medical errors may occur. RESULTS Health information technology systems support several phases of the laboratory testing process, from ordering the test to following-up with patients. This is a growing field of research with most studies focusing on the use of information technology during the final phases of the laboratory total testing process. The findings were largely positive. Positive impacts included easier access to test results by primary care providers, reduced turnaround times, and increased prescribed tests based on best practice guidelines. Negative impacts were reported in several studies: paper-based processes employed in parallel to the electronic process increased the potential for medical errors due to clinicians' cognitive overload; systems deemed not reliable or user-friendly hampered clinicians' performance; and organizational issues arose when results tracking relied on the prescribers' memory. DISCUSSION The potential of health information technology lies not only in the exchange of health information, but also in knowledge sharing among clinicians. This review has underscored the important role played by cognitive factors, which are critical in the clinician's decision-making, the selection of the most appropriate tests, correct interpretation of the results and efficient interventions. CONCLUSIONS By providing the right information, at the right time to the right clinician, many IT solutions adequately support the laboratory testing process and help primary care clinicians make better decisions. However, several technological and organizational barriers require more attention to fully support the highly fragmented and error-prone process of laboratory testing.
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Affiliation(s)
- Éric Maillet
- Faculty of Medicine and Health Sciences, School of Nursing, University of Sherbrooke, 150, place Charles-Le Moyne, Longueuil, Québec, Canada, J4K 0A8.
| | - Guy Paré
- Information Technology Department, HEC Montréal, Montréal, Québec, Canada.
| | - Leanne M Currie
- School of Nursing University of British Columbia, Vancouver, British Columbia, Canada.
| | - Louis Raymond
- Institut de recherche sur les PME, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Ana Ortiz de Guinea
- Information Technology Department, HEC Montréal, Montréal, Québec, Canada; Department of Strategy and Information Systems Deusto Business School, Universidad de Deusto (Spain).
| | | | - Josianne Marsan
- Department of Management Information Systems, Université Laval, Québec, Canada.
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Slovis BH, Nahass TA, Salmasian H, Kuperman G, Vawdrey DK. Asynchronous automated electronic laboratory result notifications: a systematic review. J Am Med Inform Assoc 2018; 24:1173-1183. [PMID: 28520977 DOI: 10.1093/jamia/ocx047] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/11/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To systematically review the literature pertaining to asynchronous automated electronic notifications of laboratory results to clinicians. Methods PubMed, Web of Science, and the Cochrane Collaboration were queried for studies pertaining to automated electronic notifications of laboratory results. A title review was performed on the primary results, with a further abstract review and full review to produce the final set of included articles. Results The full review included 34 articles, representing 19 institutions. Of these, 19 reported implementation and design of systems, 11 reported quasi-experimental studies, 3 reported a randomized controlled trial, and 1 was a meta-analysis. Twenty-seven articles included alerts of critical results, while 5 focused on urgent notifications and 2 on elective notifications. There was considerable variability in clinical setting, system implementation, and results presented. Conclusion Several asynchronous automated electronic notification systems for laboratory results have been evaluated, most from >10 years ago. Further research on the effect of notifications on clinicians as well as the use of modern electronic health records and new methods of notification is warranted to determine their effects on workflow and clinical outcomes.
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Affiliation(s)
- Benjamin H Slovis
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas A Nahass
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Hojjat Salmasian
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- The Value Institute, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gilad Kuperman
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- Department of Information Systems, NewYork-Presbyterian Hospital, New York, NY, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
- The Value Institute, NewYork-Presbyterian Hospital, New York, NY, USA
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Assessing Clinical Microbiology Practice Guidelines: American Society for Microbiology Ad Hoc Committee on Evidence-Based Laboratory Medicine Practice Guidelines Assessment. J Clin Microbiol 2017; 55:3183-3193. [PMID: 28835476 DOI: 10.1128/jcm.01124-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
As part of the American Society for Microbiology (ASM) Evidence-Based Laboratory Medicine Practice Guidelines Committee of the Professional Practice Committee, an ad hoc committee was formed in 2014 to assess guidelines published by the committee using an assessment tool, Appraisal of Guidelines for Research Evaluation II (AGREE II). The AGREE II assessment helps reviewers determine whether published guidelines are robust, transparent, and clear in presenting practice recommendations in a standardized manner. Identifying strengths and weaknesses of practice guidelines by ad hoc assessments helps with improving future guidelines through the participation of key stakeholders. This minireview describes the development of the ad hoc committee and results from their review of several ASM best practices guidelines and a non-ASM practice guideline from the Emergency Nurses Association.
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Piva E, Sciacovelli L, Pelloso M, Plebani M. Performance specifications of critical results management. Clin Biochem 2017; 50:617-621. [DOI: 10.1016/j.clinbiochem.2017.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
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Keng TB, De La Salle B, Bourner G, Merino A, Han JY, Kawai Y, Peng MT, McCafferty R. Standardization of haematology critical results management in adults: an International Council for Standardization in Haematology, ICSH, survey and recommendations. Int J Lab Hematol 2016; 38:457-71. [PMID: 27426950 DOI: 10.1111/ijlh.12526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/18/2016] [Indexed: 01/28/2023]
Abstract
INTRODUCTION These recommendations are intended to develop a consensus in the previously published papers as to which parameters and what values should be considered critical. A practical guide on the standardization of critical results management in haematology laboratories would be beneficial as part of good laboratory and clinical practice and for use by laboratory-accrediting agencies. METHODS A working group with members from Europe, America, Australasia and Asia was formed by International Council for Standardization in Haematology. A pattern of practice survey of 21 questions was distributed in 2014, and the data were collected electronically by Survey Monkey. The mode, or most commonly occurring value, was selected as the threshold for the upper and lower alert limits for critical results reporting. RESULTS A total of 666 laboratories submitted data to this study and, of these, 499 submitted complete responses. Full blood count critical results alert thresholds, morphology findings that trigger critical result notification, critical results alert list, notification process and maintenance of critical results management protocol are described. This international survey provided a snapshot of the current practice worldwide and has identified the existence of considerable heterogeneity of critical results management. CONCLUSION The recommendations in this study represent a consensus of good laboratory practice. They are intended to encourage the implementation of a standardized critical results management protocol in the laboratory.
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Affiliation(s)
- T B Keng
- Sullivan Nicolaides Pathology, Indooroopilly, QLD, Australia.
| | - B De La Salle
- UK National External Quality Assessment Scheme for Haematology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - G Bourner
- Laboratory Consultant, Guelph, ON, Canada
| | - A Merino
- Hemotherapy and Hemostasis Department, Hospital Clínic, Barcelona, Spain
| | - J-Y Han
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Y Kawai
- Sanno Affiliate Hospital, International University of Health &Welfare, Tokyo, Japan
| | - M T Peng
- National Center for Clinical Laboratories (NCCL), Beijing, China
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Awais M, Hilal K, Waheed A, Khattak YJ, Rehman A, Ul-Ain Baloch N. Detection and Communication of Critical Findings Noted on Thoracic CT Scans by Radiology Residents. J Am Coll Radiol 2015; 12:1324-9. [PMID: 26412748 DOI: 10.1016/j.jacr.2015.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/19/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Muhammad Awais
- Department of Radiology, Aga Khan University Hospital, Karachi, Sindh, Pakistan.
| | - Kiran Hilal
- Department of Radiology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Adeel Waheed
- Department of Radiology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Yasir Jamil Khattak
- Department of Radiology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Abdul Rehman
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Noor Ul-Ain Baloch
- Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Chandrajay D, Narayanan D, Barth JH. Evaluation of the effect of clinical validation of out of hours critical laboratory results. Ann Clin Biochem 2015; 53:274-8. [PMID: 26092980 DOI: 10.1177/0004563215595251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 11/17/2022]
Abstract
AIM The aim of the study was to review the clinical validation process of out of hours critical biochemistry results by a clinical biochemist and its effect on primary care services. METHODS A prospective study was conducted of all critical results for primary care patients who were analysed out of hours. The nine-month study period was conducted between June 2013 and February 2014. The data collected include patients' age, clinical details, critical results and the urgency of result communicated. The patients' subsequent attendance rate at the emergency department in the local hospital was reviewed. RESULTS A total of 311 out of hours critical results were identified in the laboratory. After clinical validation, 110 (35.4%) results were telephoned urgently and 155 (49.8%) results were deferred to the next day. Forty-six (14.8%) results were not telephoned. Following the urgent result communication, 53/110 (48.2%) patients attended the hospital emergency department within 24 h and 17/110 (15.5%) had their repeat blood test by their general practitioner surgery within 48 h. When the result was telephoned during working hours the next day, only 15/155 (9.7%) attended the hospital acute services within 48 h and 16/155 (10.3%) had repeat blood test at their general practitioner surgery. CONCLUSION In our practice, the clinical validation of out of hours critical results by a clinical biochemist is associated with a reduction in the number of results telephoned when compared against the critical limits list recommended by the Royal College of Pathologists and may focus out of hours clinical activity on more suitable patients.
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Affiliation(s)
- Deepak Chandrajay
- Blood Sciences, Old Medical School, Leeds General Infirmary, Leeds, UK
| | - Deepa Narayanan
- Blood Sciences, Old Medical School, Leeds General Infirmary, Leeds, UK
| | - Julian H Barth
- Blood Sciences, Old Medical School, Leeds General Infirmary, Leeds, UK
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Kopcinovic LM, Trifunović J, Pavosevic T, Nikolac N. Croatian survey on critical results reporting. Biochem Med (Zagreb) 2015; 25:193-202. [PMID: 26110031 PMCID: PMC4470108 DOI: 10.11613/bm.2015.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/28/2015] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Poor harmonization of critical results management is present in various laboratories and countries, including Croatia. We aimed to investigate procedures used in critical results reporting in Croatian medical biochemistry laboratories (MBLs). MATERIALS AND METHODS An anonymous questionnaire, consisting of 24 questions/statements, related to critical results reporting procedures, was send to managers of MBLs in Croatia. Participants were asked to declare the frequency of performing procedures and degree of agreement with statements about critical values reporting using a Likert scale. Total score and mean scores for corresponding separate statements divided according to health care setting were calculated and compared. RESULTS Responses from 111 Croatian laboratories (48%) were analyzed. General practice laboratories (GPLs) more often re-analyzed the sample before reporting the critical result in comparison with the hospital laboratories (HLs) (score: 4.86 (4.75-4.96) vs. 4.49 (4.25-4.72); P=0.001) and more often reported the critical value exclusively to the responsible physician compared to HLs (4.46 (4.29-4.64) vs. 3.76 (3.48-4.03), P<0.001). High total score (4.69 (4.56-4.82)) was observed for selection of the critical results list issued by the Croatian Chamber of Medical Biochemistry (CCMB) indicating a high harmonization level for this aspect of critical result management. Low total scores were observed for the statements regarding data recording and documentation of critical result notification. CONCLUSIONS Differences in practices about critical results reporting between HLs and GPLs were found. The homogeneity of least favorable responses detected for data recording and documentation of critical results notification reflects the lack of specific national recommendations.
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Affiliation(s)
| | - Jasenka Trifunović
- Department of Medical Biochemistry, Special Hospital for Medical Rehabilitation Varazdinske Toplice, Varazdinske Toplice, Croatia
| | - Tihana Pavosevic
- Department of Clinical Laboratory Diagnostics, Clinical Hospital Centre Osijek, Osijek, Croatia
| | - Nora Nikolac
- University Department of Chemistry, University Hospital Sestre Milosrdnice, Zagreb, Croatia
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Abstract
AbstractThe current failure to evidence any link between laboratory tests, clinical decision-making and patient outcomes, and the scarcity of financial resources affecting healthcare systems worldwide, have put further pressure on the organization and delivery of laboratory services. Consolidation, merger, and laboratory downsizing have been driven by the need to deliver economies of scale and cut costs per test while boosting productivity. Distorted economics, based on payment models rewarding volume and efficiency rather than quality and clinical effectiveness, have underpinned the entrance of clinical laboratories into the production industry thus forcing them to relinquish their original mission of providing medical services. The sea change in laboratory medicine in recent years, with the introduction of ever newer and ever more complex tests, including ‘omics’, which impact on clinical decision-making, should encourage clinical laboratories to return to their original mission as long as payments models are changed. Rather than being considered solely in terms of costs, diagnostic testing must be seen in the context of an entire hospital stay or an overall payment for a care pathway: the testing process should be conceived as a part of the patient’s entire journey.
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Laboratory critical values: Automated notification supports effective clinical decision making. Clin Biochem 2014; 47:1163-8. [DOI: 10.1016/j.clinbiochem.2014.05.056] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/15/2014] [Accepted: 05/19/2014] [Indexed: 11/23/2022]
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Price CP. Editorial: Automated critical value reporting; a contribution to systematization of clinical care and the value of laboratory medicine. Clin Biochem 2014; 47:1161-2. [PMID: 25091938 DOI: 10.1016/j.clinbiochem.2014.07.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Christopher P Price
- Department of Primary Care Health Sciences, University of Oxford, Oxford, U K.
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Lin SW, Kang WY, Lin DT, Lee J, Wu FL, Chen CL, Tseng YJ. Comparison of warfarin therapy clinical outcomes following implementation of an automated mobile phone-based critical laboratory value text alert system. BMC Med Genomics 2014; 7 Suppl 1:S13. [PMID: 25079609 PMCID: PMC4101312 DOI: 10.1186/1755-8794-7-s1-s13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Computerized alert and reminder systems have been widely accepted and applied to various patient care settings, with increasing numbers of clinical laboratories communicating critical laboratory test values to professionals via either manual notification or automated alerting systems/computerized reminders. Warfarin, an oral anticoagulant, exhibits narrow therapeutic range between treatment response and adverse events. It requires close monitoring of prothrombin time (PT)/international normalized ratio (INR) to ensure patient safety. This study was aimed to evaluate clinical outcomes of patients on warfarin therapy following implementation of a Personal Handy-phone System-based (PHS) alert system capable of generating and delivering text messages to communicate critical PT/INR laboratory results to practitioners' mobile phones in a large tertiary teaching hospital. METHODS A retrospective analysis was performed comparing patient clinical outcomes and physician prescribing behavior following conversion from a manual laboratory result alert system to an automated system. Clinical outcomes and practitioner responses to both alert systems were compared. Complications to warfarin therapy, warfarin utilization, and PT/INR results were evaluated for both systems, as well as clinician time to read alert messages, time to warfarin therapy modification, and monitoring frequency. RESULTS No significant differences were detected in major hemorrhage and thromboembolism, warfarin prescribing patterns, PT/INR results, warfarin therapy modification, or monitoring frequency following implementation of the PHS text alert system. In both study periods, approximately 80% of critical results led to warfarin discontinuation or dose reduction. Senior physicians' follow-up response time to critical results was significantly decreased in the PHS alert study period (46.3% responded within 1 day) compared to the manual notification study period (24.7%; P = 0.015). No difference in follow-up response time was detected for junior physicians. CONCLUSIONS Implementation of an automated PHS-based text alert system did not adversely impact clinical or safety outcomes of patients on warfarin therapy. Approximately 80% immediate recognition of text alerts was achieved. The potential benefits of an automated PHS alert for senior physicians were demonstrated.
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Campbell C, Horvath A. Harmonization of critical result management in laboratory medicine. Clin Chim Acta 2014; 432:135-47. [DOI: 10.1016/j.cca.2013.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 01/08/2023]
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Piva E, Plebani M. From “panic” to “critical” values: which path toward harmonization? Clin Chem Lab Med 2013; 51:2069-71. [DOI: 10.1515/cclm-2013-0459] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Campbell CA, Horvath AR. Towards harmonisation of critical laboratory result management - review of the literature and survey of australasian practices. Clin Biochem Rev 2012; 33:149-60. [PMID: 23267247 PMCID: PMC3529552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Timely release and communication of critical test results may have significant impact on medical decisions and subsequent patient outcomes. Laboratories therefore have an important responsibility and contribution to patient safety. Certification, accreditation and regulatory bodies also require that laboratories follow procedures to ensure patient safety, but there is limited guidance on best practices. In Australasia, no specific requirements exist in this area and critical result reporting practices have been demonstrated to be heterogeneous worldwide.Recognising the need for agreed standards and critical limits, the AACB started a quality initiative to harmonise critical result management throughout Australasia. The first step toward harmonisation is to understand current laboratory practices. Fifty eight Australasian laboratories responded to a survey and 36 laboratories shared their critical limits. Findings from this survey are compared to international practices reviewed in various surveys conducted elsewhere. For the successful operation of a critical result management system, critical tests and critical limits must be defined in collaboration with clinicians. Reporting procedures must include how critical results are identified; who can report and who can receive critical results; what is an acceptable timeframe within which results must be delivered or, if reporting fails, what escalation procedures should follow; what communication channels or systems should be used; what should be recorded and how; and how critical result procedures should be maintained and evaluated to assess impact on outcomes.In this paper we review the literature of current standards and recommendations for critical result management. Key elements of critical result reporting are discussed in view of the findings of various national surveys on existing laboratory practices, including data from our own survey in Australasia. Best practice recommendations are made that laboratories are expected to follow in order to provide high quality and safe service to patients.
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Affiliation(s)
- CA Campbell
- SEALS Department of Clinical Chemistry, Prince of Wales Hospital
| | - AR Horvath
- SEALS Department of Clinical Chemistry, Prince of Wales Hospital
- Screening and Test Evaluation Program, School of Public Health, University of Sydney
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2031, Australia
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Critical results communication: still an open issue. Clin Biochem 2012; 46:184. [PMID: 23063985 DOI: 10.1016/j.clinbiochem.2012.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 09/20/2012] [Indexed: 11/21/2022]
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