Dear colleague,
In our laboratory information system (the labcomputer) we have
implemented so called "repeat-periods" for many tests. The repeat
period can be set to a different number of day's for out-patients,
clinical patients and patients of general practitioners, this of course
in a test-specific way.
If a test is re-ordered within the repeat-period, a warning message
("request within repeat-period") is displayed automatically to the
technician entering the request. At this point the technician denies
the request unless specific action not to do so has been taken.
This specific action can be a telephone call by the doctor to the
clinical chemist explaining why the extra measurement is
necessary or a written comment/question on the form. If a test is
denied due to a repeat-period we report "test already done at
ddmmyy, at that time the result was x". This gives doctor B an
answer if doctor A asked for a test recently.
The repeat-periods implemented are based on literature and
practice and are discussed in our regular feedback-meetings with
the different disciplines. An overview of all repeat-periods is
communicated regularly. If you want I can send you an overview.
For the implementation we used the salami-tactic: only one test or
a few tests at a time. Our argument used was that doctor B from
discipline Y does not know what doctor A from discipline X has
already ordered and that we wanted to prevent unnecessary double
work (which was true). We almost met no opposition.
On our request-forms we have a check-mark "deny repeat-period".
When checked we grant the request even within the repeat-period.
However, when we feel the check-mark is routinely used we
contact the doctor. If things don't improve then we tell the doctor
we are going to ignore his or her check-marks for "deny repeat
period". On a regular basis we generate an overview out of our lab
computer of who checked "deny repeat-period" how many times.
This easily identifies people we have to talk with.......;-)
Best regards,
Christian
dr. C.H.H. Schoenmakers, EurClinChem
Clinical Chemist
Department of Clinical Chemistry, Elkerliek Hospital
P.O. box 98, 5700 AB Helmond
The Netherlands
(+)31-492-595555 (tel), (+)31-492-595691 (fax)
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