Up to 70 percent of errors associated with lab results happen way before the tests are even analyzed, according to a report from ECRI Institute’s Patient Safety Organization. Getting a delayed diagnosis or misdiagnosis, particularly for what could be life-threatening conditions, can create significant emotional distress for patients.
Dr. Karen P. Zimmer, ECRI Institute medical director, told MedCity News that the information collected by its Patient Safety Organization comes not just from acute care hospitals but also health systems, physician offices and specialty practices. “A lot of people think these errors occur in the laboratory, but the literature supports our finding that errors are happening with care providers in the pre-analytic and post-analytic stages.” She added that these mistakes are not limited to inpatient or outpatient care.
Here are five strategies institutions are implementing recommended by ECRI.
Implement bar code identification system. To help remedy patient misidentification and specimen labeling errors, the report recommends setting up a bar code identification system. Brigham and Women’s Hospital has used a blood test collection process for inpatients that included bar-coded patient wristbands, mobile devices for downloading orders, bar code scanners to confirm patient identity before blood tests were collected and portable printers to produce labels at the patient’s bedside. A study on the new system found that a higher percentage of patients reported having their wristband checked before a phlebotomy and reduced the number of specimen identification errors. Zimmer cautions that healthcare facilities need to ensure that these programs are developed to fit in with staff work flow.
Provide automatic transmission of reports by computer, pager or other electronic formats. Having an iPad or iPhone, or other mobile devices to facilitate the identification of patients, samples collected by hospital staff and transmission of lab results to relevant physicians or clinicians could make a significant difference.
Learn from mistakes and near misses. Identify the source of the problem. Was it a human error or equipment error? Was it a sample mix-up or simply a matter of not getting enough of a sample? Was it a quality-control failure? Or was the error caused by a communication breakdown?
Establish clear format for reporting results. Oftentimes, the obvious or simple solution is overlooked. Healthcare facilities should establish clear protocols for patient and specimen identification to avoid mix-ups. Some ways they could do this would be to use two patient identifiers or labeling the specimen in front of the patient. Having a policy where lab results are read back aloud could also help.
Set up facility-wide protocols. Healthcare facilities could do this by providing tighter definitions of criteria such as critical results, providing a time frame for reporting the results and mapping out a process to notify the ordering clinician when results are ready. Lab directors tend to focus on what’s going on in their lab, says Zimmer, but they should also work to build liaisons with care provider staff to improve communication. If specimens are not properly labeled, labs must reject them, but they should also provide feedback so the reason behind the rejection is clear, says Zimmer.