Hi,

at Birmingham Heartlands we have agreed the following protocols (based on ones supplied by Stephen Halloran and modified on local agreement) which are for the Emergancy department and Acute Medical Unit.

The attached poster is a model of what was expected to happen on introduction. I've just put a poster abstract in to Focus which hopefully will get in but below is a copy of it.

Essentially we've coupled some decision support (requesting based on presentation profiles) and starting to introduce some dashboarding type things for feedback in the lab.

On one level you could argue that electronic requesting hasn't made much of an impact on say turnaround times (the main determinant is still logistics) but in another sense it has made an impact on the economics (less tests done).

In terms of processing the samples in the lab, turnaround time is improved due to easier booking in but mainly because we reduce the number of tests that have long incubation times and slow everything down (e.g. TSH, B12/Folate)

The main complaint from the users is that the system is slow from their perspective (this is because we are increasing the data quality).

So overall from the user perspective there is little benefit from electronic requesting but from lab point of view there are (easier processing) and from a Clinical Director's point of view there are (reduced lab spend).

Overall, from this I think the major issues in all this are actually down to the people involved and I think more effort in the usability side of things will bring the biggest benefits.

Introduction of electronic requesting and demand management into the ED Department, Does it Work?

Introduction

Order communications coupled with systems that guide the requesting process have the potential to realise benefits for the laboratory and service users.

Aims

Enable medical staff to request profiles on the basis of clinical
presentation rather than selecting individual tests
Allow medical staff security in the testing process in that they have requested the right tests
Allow laboratory staff to process samples from acute medicine quickly and efficiently
Reduce waste (Inappropriate tests)
Improve turnaround times of tests

Methods

Electronic requesting was implemented in Emergency Department of Birmingham Heartlands Hospital in-conjunction with a simplified approach to test requesting based on the patients diagnosis.

Results

Modelling of requesting patterns indicated that implementation of a successful system could result in a total reduction in turnaround time of 31% and a reduction in number of tests requested of 24%.

The system has had wide spread uptake with on average 89.5% of biochemistry and haematology tests being requested electronically over a 5 month period.

In terms of user perception, the system is perceived to slower than existing paper based systems.

Turnaround times have decreased only slightly (by on average 4 minutes) however the variability in turnaround times has reduced considerably.

There has been a reduction in the number of tests requested by 10.2%. At the same time there has been an 8.1% increase in the number of samples taken. 

The set to request ratio has been reduced by 1 from 4 to 3

Conclusions

Electronic requesting coupled with demand management has been an effective way of reducing the volume of testing done by the Emergency Department.

It has so far had a minimal impact on the overall turnaround of tests. Analysis of sample flows after introduction, indicate that the pre-analytical phase requires further work. This appears to be unrelated to the method of requesting.

Electronic requesting appears to be an effective method of reducing the variability in turnaround times.




-----Original Message-----
From: Clinical biochemistry discussion list on behalf of O'Connor John (Royal Devon and Exeter Foundation Trust)
Sent: Mon 1/31/2011 14:51
To: [log in to unmask]
Subject: Order sets
 
Dear Collective

 

Do any list members have access to evidence based/ clinically agreed order sets that they would be prepared to share?. It would also be useful to know if any audit was carried out to evaluate the impact of their introduction and whether they are being adopted by pan pathology networks.

 

IBW John 

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