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Innovative strategy for effective critical laboratory result management: end-to-end process using automation and manual call centre
  1. Lian Kah Ti1,
  2. Sophia Bee Leng Ang1,
  3. Sharon Saw2,
  4. Sunil Kumar Sethi2,
  5. James W L Yip3
  1. 1Department of Anaesthesia, Yong Loo Lin School of Medicine, National University Health System, Singapore, Republic of Singapore
  2. 2Department of Laboratory Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Republic of Singapore
  3. 3Department of Cardiology, Yong Loo Lin School of Medicine, National University Health System, Singapore, Republic of Singapore
  1. Correspondence to Dr Lian Kah Ti, Department of Anaesthesia, Yong Loo Lin School of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore; lian_kah_ti{at}nuhs.edu.sg

Abstract

Background Timely reporting and acknowledgement are crucial steps in critical laboratory results (CLR) management. The authors previously showed that an automated pathway incorporating short messaging system (SMS) texts, auto-escalation, and manual telephone back-up improved the rate and speed of physician acknowledgement compared with manual telephone calling alone. This study investigated if it also improved the rate and speed of physician intervention to CLR and whether utilising the manual back-up affected intervention rates.

Methods Data from seven audits between November 2007 and January 2011 were analysed. These audits were carried out to assess the robustness of CLR reporting process in the authors' institution. Comparisons were made in the rate and speed of acknowledgement and intervention between the audits performed before and after automation. Using the automation audits, the authors compared intervention data between communication with SMS only and when manual intervention was required.

Results 1680 CLR were reported during the audit periods. Automation improved the rate (100% vs 84.2%; p<0.001) and speed (median 12 min vs 23 min; p<0.001) of CLR acknowledgement. It also improved the rate (93.7% vs 84.0%, p<0.001) and speed (median 21 min vs 109 min; p<0.001) of CLR intervention. From the automation audits, the use of SMS only did not improve physician intervention rates.

Discussion The automated communication pathway improved physician intervention rate and time in tandem with improved acknowledgement rate and time when compared with manual telephone calling. The use of manual intervention to augment automation did not adversely affect physician intervention rate, implying that an end-to-end pathway was more important than automation alone.

  • Laboratory medicine
  • communication
  • healthcare quality improvement
  • information technology
  • audit and feedback
  • patient safety
  • human error
  • anaesthesia

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by National Healthcare Group, Singapore.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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