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Diagnostic laboratory professionals have an important role to play in ensuring patient safety. The chance for human errors and omissions is high in specimen collection, testing and blood transfusions because these processes have so many manual steps.

Automating specimen collection and transfusion management can create closed loop systems that virtually eliminate errors in labeling of specimens, incorrect patient draws and incorrect transfusions.

Adding specimen collection management and transfusion management solutions to the laboratory information system (LIS) promotes patient safety by ensuring specimens are collected from the right patient, for the right tests, at the right time, with the right indicators, for the right diagnosis.

In addition to a significant improvement in patient safety, automating results in cost efficiencies, improved quality of care and increased revenues.

Hospital research conducted in the U.S. and Canada quantifies the values of automation and suggests return on investment (ROI) in automation systems is extremely high.

In a case study of one sample hospital, an investment of about $600,000 generated a positive return in less than 1 year, with a 3-year net present value (NPV) of $3.8 million and an 820 percent ROI. 

Key Patient Safety Challenges
Sunquest Information Systems interviewed LIS managers, laboratory directors and managers, physicians, pathologists and IT support managers at 15 hospitals in the U.S. and Canada, and asked them about the challenges they face in specimen collection and testing and blood transfusion.

Their responses fell into four main areas:

1. Matching patients and test--The need for positive patient identification programs is paramount to patient safety, ensuring the right patient is matched to the right tests, procedures and products.
   
   When done manually, this process can be time consuming and prone to human error. Patients can become separated from their wristbands or staff may fail to conduct properly all steps of a bedside check, resulting in incorrect or incomplete patient identification.

This point is well illustrated by a 2003 audit of transfusion procedures in 660 hospitals, which showed during bedside identification checks, there was a failure to:

• ask patient name and match to wristband 57 percent of the time;
• match wristband ID to the blood bag label 24 percent of the time;
• match wristband data with the request form 46 percent of the time;
• check results of compatibility testing and expiration 27 percent of the time; and
• do all four of the bedside check steps correctly 75 percent of the time.

2. Tracking test requests--There are many manual steps required from test order request to specimen receipt into the lab and these manual touch-points can lead to human error.

For example, phlebotomists often travel from the labs with multiple sets of labels for multiple patient draws that need to be made, creating the risk that the wrong labels are affixed to the specimens once drawn.

If the patient is not available for a scheduled draw, the phlebotomist must also make a note of this and remember to alert the lab that the draw did not take place and needs to be rescheduled.

3. Speed versus safety--Reducing turnaround times (TAT) for labs, emergency departments (EDs), and other areas of the hospital while ensuring that the right results are matched with the right patient and delivered in near real-time is critical, so treatment decisions can be expedited with maximum data.

KNOW YOUR PATIENT: Patient identification is key to improving patient safety. ADVANCE photo

In addition, the inability to instantly record results into the patient's electronic medical records (EMR) and consolidate them with the previous patient history can reduce the chances that the most effective course of treatment is delivered, or result in an incorrect course of treatment because a previously existing condition is not known.

Lab capacity can also be restricted by long turnaround times, allowing fewer patient results to be delivered at any given time. This is also true of areas like the ED, where long turnaround times can result in fewer patients being seen or longer wait times before medical care can be given.

Using an automated system, for example, Sunquest's Collection Manager dramatically decreases TAT in the ED. In the case study described in detail below, the hospital ED reduced TAT from 65 minutes to 46 minutes per test, increasing capacity, and netting more than one million dollars in annual incremental revenue.

4. Dealing with errors--Lost or mislabeled specimens or incorrectly administered products or procedures can result in significant follow-up time to determine why the error occurred and how to prevent it in the future.

The worst cases may result in serious adverse events. The time and number of staff required to follow-up on errors can be extensive, averaging anywhere from 2-3 hours to 1-2 weeks, and including phlebotomists, nurses, physicians, lab techs, lab managers, CMO's, safety officers and legal staff.

An error might also result in significant financial impact, including lack of reimbursement for added patient care, increased insurance premiums, or legal action taken against the facility. One study found one in 18 sample identification errors led directly to an adverse event.

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