Lab UV SB Problem
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Universal Storyboard - Specimen Problem
A 57 year old woman with multiple medical problems presents to the ER. Multiple laboratory tests are drawn into several tube types and sent to the clinical laboratory with an associated electronic order for testing. A problem in transport results in damage to several tubes, though several additional tubes remain usable. The available sample is inadequate for all tests ordered. The volume and tube types of the intact specimens allow several different combinations of tests to be run among those that were ordered, and the selection of the most useful combination depends on the patient's clinical status. On recognition of the problem, its description is captured into a problem database for later follow up and a message is returned to the ordering system prior to testing that provides notice of the loss of specimen and presents alternatives for testing on the available specimens. In the meantime, the patient has been admitted to the hospital and the data from the message is displayed to the physician on the hospital floor. The physician chooses the most useful combination of tests to run immediately and schedules a follow up blood draw to provide specimens for the remaining tests. The information is returned to the LIS where the initial order is amended and the follow up blood draw is scheduled as a new procedure.
Laboratories often deal with sample problems (breakage or other damage, loss, incorrect collection or containers, insufficient volume, inadequate information). The communication and resolution of these problems is currently managed outside of information systems, and resulting order amendments are managed manually. Correction of a problem is often time consuming and error prone as the laboratory tries to find someone who can amend or make other decisions related to the initial order and any necessary follow up, particularly if the patient changes locations. Documentation of these problems for process improvement is resource-intensive or not done. This new process would allow the response to a sample problem to be automated, logged, tracked, and included in QA studies. The ordering and resulting systems support resolution of the immediate problem including amendment of orders as necessary. The problem and its resolution becomes part of the medical record. In the scenario above, the patient had left the ER by the time the problem notification arrived, but because the notification was passed to the EHR it followed the patient into the hospital and to the point of clinical decision-making.
TBD (to be documented)
Universal Storyboard - Specimen Problem Reference Lab
A woman admitted to a community hospital with a putative diagnosis of lupus erythematosus has several laboratory tests drawn that are received by the local clinical laboratory and shipped to a reference laboratory for testing, with an order transmitted via their reference laboratory interface. On arrival it is found that the specimen is of inadequate volume for the tests ordered. A return message is generated prior to testing indicating the problem, the tests (if any) that can be carried out on the available specimen, and the amount and type of additional specimen needed. The local laboratory receives the message. If it has appropriate specimen available, it can elect to ship that immediately to complete the original order. Otherwise, the laboratory can pass the message back to the ordering physician for amendment of the original order and/or additional sampling.
Problems with specimens may occur either in local laboratories or reference laboratories. In a reference laboratory setting, the local laboratory should receive notification of problems first and may be able to resolve problems using extra specimen volume or information that is already in the lab. If that cannot be done, the problem notification should be passed back to the ordering physician for review and a clinical decision. If the local laboratory can partially but not completely resolve a problem, it should indicate that in a notation passed back to the ordering physician.
TBD (to be documented)