scholarly journals Implementation of Laboratory Review of Test Builds Within the Electronic Health Record Reduces Errors

2019 ◽  
Vol 144 (6) ◽  
pp. 742-747
Author(s):  
Courtney Barry ◽  
Tina Bocker Edmonston ◽  
Snehal Gandhi ◽  
Kennedy Ganti ◽  
Nami Kim ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Laboratory Data ◽  
Diagnostic Errors ◽  
Third Party ◽  
Error Message ◽  
Review Team ◽  
Electronic Health ◽  
The Impact ◽  
Clinical Laboratory Improvement Amendments ◽  
Regular Review

Context.— As electronic health records (EHRs) become more ubiquitous, physicians have come to expect that laboratory data from a variety of sources will be incorporated into the EHR in a structured format. The Clinical Laboratory Improvement Amendments have standards for data transmission traditionally met by pathologist review of their own hospital laboratory information system transmissions. However, with third-party laboratory data now being sent through external (nonhospital laboratory) interfaces, ownership of this review is less clear. Lack of an expert laboratory review process prior to changes being implemented can result in mapping and interfacing errors that could lead to misinterpretation and diagnostic errors. Objective.— To determine the impact of retrospective and prospective laboratorian-assisted review on the volume of interface errors and new builds. Design.— A seminal event led to a restructuring of the process for review of EHR laboratory builds, using laboratory expertise. Results.— A review of 26 500 test result fields found 61 of 4282 (1.4%) unique codes that could have led to misinterpretation. These were corrected and a process for proactive review and maintenance by laboratory experts was implemented. This resulted in monthly decreases in outbound error message from 4270 to 1820 (57.4%), in new test builds from 586 to 274 (53.2%), and in new result builds from 1116 to 552 (50.5%). Conclusions.— Regular review and maintenance of external laboratory test builds in EHRs by a laboratory review team reduces interface error messages and reduces the number of new builds required for results to file into the EHR.

scholarly journals Graphical display of diagnostic test results in electronic health Records: a comparison of 8 systems

2015 ◽  
Vol 22 (4) ◽  
pp. 900-904 ◽  
Author(s):  
Dean F Sittig ◽  
Daniel R Murphy ◽  
Michael W Smith ◽  
Elise Russo ◽  
Adam Wright ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Laboratory Test ◽  
Clinical Laboratory ◽  
Negative Impact ◽  
Laboratory Data ◽  
Test Results ◽  
Health Records ◽  
Laboratory Test Results ◽  
Data Points ◽  
Electronic Health

Abstract Accurate display and interpretation of clinical laboratory test results is essential for safe and effective diagnosis and treatment. In an attempt to ascertain how well current electronic health records (EHRs) facilitated these processes, we evaluated the graphical displays of laboratory test results in eight EHRs using objective criteria for optimal graphs based on literature and expert opinion. None of the EHRs met all 11 criteria; the magnitude of deficiency ranged from one EHR meeting 10 of 11 criteria to three EHRs meeting only 5 of 11 criteria. One criterion (i.e., the EHR has a graph with y-axis labels that display both the name of the measured variable and the units of measure) was absent from all EHRs. One EHR system graphed results in reverse chronological order. One EHR system plotted data collected at unequally-spaced points in time using equally-spaced data points, which had the effect of erroneously depicting the visual slope perception between data points. This deficiency could have a significant, negative impact on patient safety. Only two EHR systems allowed users to see, hover-over, or click on a data point to see the precise values of the x–y coordinates. Our study suggests that many current EHR-generated graphs do not meet evidence-based criteria aimed at improving laboratory data comprehension.

scholarly journals Bringing the clinical laboratory into the strategy to advance diagnostic excellence

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ira M. Lubin ◽  
J. Rex Astles ◽  
Shahram Shahangian ◽  
Bereneice Madison ◽  
Ritchard Parry ◽  
...  
Keyword(s):  
Quality Management ◽  
Health Care Providers ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Diagnostic Errors ◽  
Care Quality ◽  
Diagnostic Process ◽  
Management Approach ◽  
Care Providers ◽  
Medical Diagnoses

Abstract Objectives Clinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses. Content Innovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors. Summary An expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice. Outlook There are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.

Towards a new paradigm in laboratory medicine: the five rights

2016 ◽  
Vol 54 (12) ◽  
Author(s):  
Mario Plebani
Keyword(s):  
Clinical Laboratory ◽  
Laboratory Data ◽  
Diagnostic Errors ◽  
Laboratory Medicine ◽  
Expert Advice ◽  
Test Results ◽  
Analytical Quality ◽  
New Paradigm ◽  
Analytical Phase

AbstractA body of evidence collected in the last few decades demonstrates that the pre- and post-analytical phases of the testing cycle are more error-prone than the analytical phase. However, the paradigm of errors and quality in laboratory medicine has been questioned, analytical mistakes continuing to be a major cause of adverse clinical outcomes and patient harm. Although the brain-to-brain concept is widely recognized in the community of laboratory professionals, there is lack of clarity concerning the inter-relationship between the different phases of the cycle, interdependence between the pre-analytical phase and analytical quality, and the effect of the post-analytical steps on the quality of ultimate laboratory information. Analytical quality remains the “core business” of clinical laboratories, but laboratory professionals and clinicians alike should never lose sight of the fact that pre-analytical variables are often responsible for erroneous test results and that quality biospecimens are pre-requisites for a reliable analytical phase. In addition, the pressure for expert advice on test selection and interpretation of results has increased hand in hand with the ever-increasing complexity of tests and diagnostic fields. Finally, the data on diagnostic errors and inappropriate clinical decisions made due to delay or misinterpretation of laboratory data underscore the current need for greater collaboration at the clinical-laboratory interface.

The Impact of New Regulations on Laboratory Testing in Physicians' Offices

1992 ◽  
Vol 38 (7) ◽  
pp. 1273-1279
Author(s):  
D J Loschen
Keyword(s):  
Laboratory Testing ◽  
Clinical Laboratory ◽  
Practice Group ◽  
Laboratory Services ◽  
Educational Processes ◽  
Trained Personnel ◽  
Related Group ◽  
Organized Medicine ◽  
The Impact ◽  
Clinical Laboratory Improvement Amendments

Abstract The reaction of the clinician to the specter of regulation of any part of his or her practice mirrors the reaction of the laboratorian to the implementation of Medicare and Clinical Laboratory Improvement Amendments legislation in 1965 and 1967, respectively. Whether the regulatory burdens that will be visited upon these laboratories are justified or necessary is arguable; the fact of the upcoming regulation is not. The volume and breadth of testing in physicians' office laboratories (POLs) has increased exponentially since passage of the Diagnosis Related Group legislation by Congress in 1983, an increase made possible by remarkable developments in technology. State regulatory initiatives and private accrediting agencies have been perceived as being inadequate to prevent the proliferation of poorly controlled testing in the nontraditional laboratory environment. The testing menu of a given POL varies according to the scope of clinical services offered; the size of the practice group; the funding available for equipment and personnel acquisition; and the general availability of hospital, reference, and consultative laboratory services. Physicians who offer laboratory services as part of their practices must now prepare their laboratories to meet whatever requirements are mandated by regulation. This will include acquisition of trained personnel, improvement of instrumentation and methodologies, participation in proficiency testing, establishment of comprehensive quality-assurance programs, and adequate documentation of laboratory services. Organized medicine should devote its energies to assisting with needed educational processes to assure the survival of POLs.

The computer as a diagnostic consultant, with emphasis on use of laboratory data.

1986 ◽  
Vol 32 (9) ◽  
pp. 1714-1718 ◽  
Author(s):  
J D Myers
Keyword(s):  
Laboratory Tests ◽  
Clinical Laboratory ◽  
Massachusetts General Hospital ◽  
Correct Diagnosis ◽  
Computer Systems ◽  
Laboratory Data ◽  
Diagnostic Errors ◽  
Preliminary Evidence ◽  
Preliminary Study ◽  
Complex Cases

Abstract In this preliminary study concerning the applicability of expert computer systems, such as INTERNIST-I, to providing advice to clinical pathologists regarding patients' diagnoses and the pertinence of performing further laboratory tests, 32 complex cases, drawn from Case Records of the Massachusetts General Hospital, were analyzed diagnostically by computer, on the basis of clinical laboratory data only. Half (16 cases) were diagnosed correctly, but in 15 of the rest no diagnostic conclusion could be reached. However, no diagnostic errors were made. The study provides preliminary evidence that expert computer systems can be useful to clinical pathologists and clinical internists in guiding the laboratory workup of patients toward correct diagnosis.

scholarly journals Pathology Residents as Testing Personnel in the Hematology Laboratory

2021 ◽  
Author(s):  
Claudiu V. Cotta ◽  
Sarah L. Ondrejka ◽  
Megan O. Nakashima ◽  
Karl S. Theil
Keyword(s):  
Peripheral Blood ◽  
Body Fluid ◽  
Clinical Laboratory ◽  
Turnaround Time ◽  
Self Assessment ◽  
Professional Activities ◽  
Hands On ◽  
Before And After ◽  
The Impact ◽  
Clinical Laboratory Improvement Amendments

Context.— Clinical laboratories and the training of pathology residents are tightly regulated environments. Compliance with regulatory requirements must be addressed when developing entrustable professional activities (EPAs) for pathology residents. Objective.— To describe the development of EPAs for peripheral blood and body fluid review in compliance with Clinical Laboratory Improvement Amendments and College of American Pathologists personnel and testing requirements. To examine the impact of EPA implementation on the workflow in a busy hematology laboratory. Design.— A training program was designed to prepare pathology residents to function as independent testing personnel in compliance with Clinical Laboratory Improvement Amendments. After a series of lectures, hands-on microscopy sessions, self-assessment quizzes, and achievement of a passing score on a training assessment exam, residents were deemed competent to release certain results independently. The volume and the turnaround time of hematology tests were compared before and after residents were integrated into the laboratory workflow. Faculty and residents were surveyed to assess satisfaction with the training. Results.— Empowering residents to independently release noncritical results from peripheral blood and body fluid reviews had no adverse impact on test turnaround time. The resident contribution to workflow resulted in a corresponding decrease in the number of cases that required attending pathologist review. Faculty and residents viewed the EPAs as beneficial to service and education. Conclusions.— The implementation of the EPAs had a beneficial effect on the laboratory, the trainees, and faculty. Our experience may be helpful to other training programs as EPAs become more widely implemented in residency training.

scholarly journals Impact of Physical Fitness on Cognitive Performance in Patients at a Memory Clinic

2019 ◽  
Vol 9 (1) ◽  
pp. 129-135 ◽  
Author(s):  
Katharina Gnosa ◽  
Agnies Marczak ◽  
Jana Binder ◽  
Georg Adler
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Clinical Laboratory ◽  
Early Recognition ◽  
Third Party ◽  
Step Test ◽  
Subjective Memory ◽  
Motor Fitness ◽  
History Of ◽  
The Impact

Objective: To examine the impact of cardiovascular and motor fitness on cognitive performance in subjects interested in the prevention and early recognition of Alzheimer’s dementia (AD). Methods: The data of 388 participants of a respective project aged between 50 and 85 years were evaluated. Classification of the participants into the groups of “no cognitive impairment” (NCI), “mild cognitive impairment of the amnestic type” (MCIa), and “mild AD” (mAD) was performed by neuropsychological assessment, history of third party, and further clinical, laboratory, or imaging investigations. Subjective memory impairment (SMI) and cognitive blackouts were recorded. Cardiorespiratory fitness (CRF) was assessed by means of the 2-min step test and motor fitness (MF) by means of the 30-s chair-stand test. Results: CRF and MF were reduced in participants with MCIa and mAD. They were negatively correlated with the score for cognitive blackouts. In the group of 50- to 60-year-old nondemented participants those with low CRF and MF performed poorer in various cognitive domains, had a higher score for cognitive blackouts, and more frequently SMI. Conclusion: Low CRF and MF are associated with cognitive impairment. This applies even in 50- to 60-year-old nondemented subjects without marked physical morbidity. These findings support the potential usefulness of physical exercise for dementia prevention.

A STUDY OF HEPATITIS B VIRUS GENOTYPES IN CHRONIC HEPATITIS B PATIENTS

2011 ◽  
pp. 25-29
Author(s):  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Hbv Dna ◽  
Hbv Genotypes ◽  
B Virus ◽  
Virus Genotypes ◽  
Genotype C

Aims: To measure the prevalence of HBV genotypes in chronic hepatitis B patients and their relation to HBeAg and HBV DNA level. Methods: 81 patients were enrolled in this study from January 2009 to December 2010. Clinical, laboratory data were collected during the patient’s hospitalization. Sera were quantitatively tested for HBeAg and HBV DNA. HBV genotyping was made by real-time PCR. Results: Among the 81 patients, 60.5% had genotype B, 26.7% had genotype C and 8.6% had mixed genotype B-C. Prevalence of symptoms (fatigue, anorexia, insomnia...) was higher in genotype C than in genotype B. Genotype C patients had positivity higher HBeAg than genotype B patients (56% vs. 38,8%, p <0.05). The rate of HBV DNA > 107 copies/mL was higher in genotype C group than in genotype B group (36% vs. 28,6%, p > 0.05). Conclusions: Most of the patients had genotypes B or C. Patients with genotype C had positive HBeAg and may be related to higher serological HBV DNA level than in genotype B.

Glucose Levels and Outcome After Primary Intraventricular Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 40-46
Author(s):  
Rui Guo ◽  
Ruiqi Chen ◽  
Chao You ◽  
Lu Ma ◽  
Hao Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Incidence Rate ◽  
Glucose Level ◽  
Intraventricular Hemorrhage ◽  
Laboratory Data ◽  
History Of ◽  
Poor Outcomes ◽  
The Impact

Background and Purpose: Hyperglycemia is reported to be associated with poor outcome in patients with spontaneous Intracerebral Hemorrhage (ICH), but the association between blood glucose level and outcomes in Primary Intraventricular Hemorrhage (PIVH) remains unclear. We sought to identify the parameters associated with admission hyperglycemia and analyze the impact of hyperglycemia on clinical outcome in patients with PIVH. Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes. Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders. Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.

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