PubMed · 16194014
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Heidi Learn. 2005. Web-based programs work for the lab manager.. https://pubmed.ncbi.nlm.nih.gov/16194014/
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PURPOSE: The purpose of this study was to identify the key implications of the implementation of a computerized physician order entry (CPOE) system on pathology laboratory services. METHODS: An in-depth qualitative study using observation, focus groups and interviews with pathology staff, managers, clinicians and information systems staff during implementation of a CPOE system in 2004 at a major Australian teaching hospital. RESULTS: Pathology laboratories experienced a shift in their work roles resulting in altered work practices, responsibilities and procedures. These changes were marked by terminological and procedural changes in the test order process from when clinicians issued a request for a test, to the new system that established clinical orders at the point of care. This change was accompanied by some organizational dysfunctions including the emergence of a new category of "frustrated" orders without specimens; problems with the procedure of adding tests to previously existing specimens; the appearance of discrepancies in the recorded time of specimen collection. In response to these changes, hospital and pathology staff adopted a variety of means to cope with their changed circumstances. These ranged from efforts to increase clinical awareness to compensatory laboratory workarounds and enforced rule changes. CONCLUSIONS: CPOE systems can have a major impact on the nature of the work of pathology laboratories. Understanding how and why these changes occur can be enhanced through considering the organizational and social contexts involved. The effectiveness of CPOE systems will rely on how administrators and staff approach and deal with these challenges.
The Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) detail the requirements for the cytotechnologist (CT) who evaluates gynecologic cytopathology specimens. However, the role of the CT in nongynecologic cytopathology is not clearly defined. Furthermore, non gynecologic cytopathology cases are diverse and the screening, interpretative, and diagnostic issues may be quite different from the gynecologic cases. At our institution, the CT and pathologist review nongynecologic cytopathology cases. Since CLIA '88 does not require the CT to screen nongynecologic cytopathology cases, there are few guidelines for quality assessment or quality improvement for the CT regarding nongynecologic cytopathology cases. To provide better understanding of the expectations of the CT and the needs of the pathologist, we developed a system comparing the CT's interpretation to the pathologist's interpretation as a means for enhanced communication and feedback. Using our Laboratory Information System (LIS), we generate a daily report that lists all cases with discrepancy in diagnoses between the CT and pathologist. The general supervisor reviews this report for diagnostic discrepancy in each case. To determine the degree of discrepancy, numerical values are assigned to each primary interpretation. Minor discrepancies are defined as differences less than +/-2.0. Major discrepancies are defined as differences greater than or equal to +/-2.0. For the entire laboratory, the overall percentage of concordant cases was consistently above 80% for each of the 6 mo analysis. Regarding the monthly discrepancies, the proportion of minor discrepancies ranged from 11.09% to 15.44% and the proportion of major discrepancies ranged from 1.40% to 3.56%. The frequency distribution of discrepancies by degree approximates a normal (Gaussian) curve and serves as baseline information that may be used for comparison when there are changes in practice or personnel. The CTs attend slide review sessions conducted by the general supervisor for discussion of cases with major discrepancies. The discrepancy data from individual CTs are useful in counseling and recommending areas for improvement. As the CT and pathologist work cooperatively and in tandem, our system allows for a mechanism by which the expectations and needs of pathologist are communicated to the CT more effectively. We believe our process is a fundamental step in improving CT performance in Nongynecologic cytopathology and keeps the CT informed of complexities of nongynecologic cytopathology.
OBJECTIVE: To evaluate common laboratory transcription errors made in requisition forms and rate of report failure in test result reports. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Jinnah Postgraduate Medical Center (JPMC) from February 01, till February 28, 2002. PATIENTS AND METHODS: One hundred and eight patient s records were collected randomly from 24 different departments of the hospital, during the month of February 2002. Each record was scrutinized for requisition slips and test reports. Tabulation of the content matter of all requisition slips and the test reports was done on the spread sheet, for the transcription errors; and compared with the minimum standards of requisition forms, as laid down by clinical laboratory improvement amendments; 1988 (CLIA 88). Request forms on which urgent test/any comment was given, were tabulated separately. Differences in the number of tests ordered and actually performed were also tabulated. Percentage of error was calculated. RESULTS: Four hundred and sixty-nine test request forms, requesting 1112 tests, were analyzed. None of them had pre-formatted laboratory forms. They were written on torn file papers, Out-patient department (OPD) slips and plain papers. The transcription errors included physician s identification errors (469/469 or 100%), patient s name, age, sex and unique identifier errors (0, 94, 95 and 81%) respectively, error in patients data aiding diagnosis (100%) and report failure error (37%). The requesting pattern of the laboratory tests ordered by clinicians revealed inclination towards panel-test ordering. The results of requested tests were available in 63% requested tests, and not available in 37% tests. No reason for rejection of the specimen was found on feed-back/report. Further analysis of un-reported results revealed that the emergency tests of electrolytes and sugar were the most affected ones, followed by PT/APTT, ESR and urine analysis. Tests for serum electrolytes done in elective and emergency setup, showed that out of 152 test requests for electrolytes, 124 requests were sent in elective and 28 in emergency setup. There was report failure in 84 cases (67.7%) in former and 13 cases (46.4%) in the latter. CONCLUSION: A good insight on error-prone steps in the laboratory process is essential to achieve error reduction; hence, in addition to maintaining quality standards within laboratory, it is imperative to go outside the laboratory to identify the common errors made in laboratory process and to reorganize the activity of the wards.