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BMJ Qual Saf 21:624-626 doi:10.1136/bmjqs-2012-001272
  • Editorial

Improving communication of critical laboratory results: know your process

  1. Edward E Etchells1,2
  1. 1Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
  2. 2Centre for Patient Safety, University of Toronto, Ontario, Canada
  1. Correspondence to Dr Brian M Wong, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room H466, Toronto, ON M4N 3M5, Canada; brianm.wong{at}sunnybrook.ca

Many hospitals strive to implement systems that allow for timely and reliable communication of critical laboratory results (CLRs) to the responsible physician.1–3 With recent advances in health information technology (IT), an increasing number of institutions are turning to solutions that involve varying degrees of automation to streamline this process. The use of automation to improve the efficiency and reliability of an alerting process is enticing. Many of us have benefited from automation in our day-to-day lives: Reminders in our calendars, alerts sent to our smartphones indicating our flight is delayed, or monthly withdrawals from our bank accounts to pay our bills are just a few examples. When thoughtfully designed and applied, automation can make life both more simple and reliable.

However, there is a common misconception that automation is as simple as flipping a switch that, when activated, replaces unpredictable human activity with a foolproof system that delivers the same result every time. Unfortunately, an automated solution often fails to achieve its desired outcome, in large part because the underlying process being automated has not been carefully considered.

Rushing to introduce automation without careful planning to account for existing clinical processes is the Achilles' heel of any health IT implementation. A study of computerised provider order entry (CPOE) implementation in a paediatric intensive care unit (ICU) that purportedly increased mortality offers a sobering example of the potential risks of premature implementation.4 Before CPOE implementation, when a child was transferred from an outside institution to their ICU, the paediatric intensivist would order medication infusions so that they could be prepared in advance, arrange for diagnostic imaging studies to be carried out immediately on arrival, and write the admission orders, all before the patient arrived. However, after CPOE implementation, none of these anticipatory actions could take …

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