Process Improvement and Operational Efficiency through Test Result Autoverification

Abstract

Through autoverification, a customized expert system within the Laboratory Information System (LIS), a computer performs the initial review and verification of test results based on a predetermined set of boundaries or rules, as established by the laboratory (1). A carefully designed system can be an important tool in addressing such crucial issues as medical errors, test turnaround time (TAT), shortages in personnel and funding, and operational efficiency. As part of an ongoing modular laboratory automation plan at John H. Stroger, Jr. Hospital of Cook County (JHSHCC, formerly Cook County Hospital, Chicago), autoverification was implemented in our clinical chemistry and urinalysis laboratories. JHSHCC is a large, urban, tertiary acute-care public hospital and trauma center that serves as the centerpiece of a countywide integrated healthcare delivery system. As part of the hospital’s clinical pathology service, the clinical chemistry laboratory provides more than 150 different test procedures in general chemistry, toxicology, drug screening, endocrinology, urinalysis, and blood gas analysis. The laboratory has modern, automated instrumentation, including preanalytical specimen processors (TECAN FE500), all of which are bidirectionally interfaced to the LIS (Soft Computer Consultants). In 2003, the clinical chemistry laboratory processed 1.3 million specimens (more than 6 million reportable results). The result-review/reporting process for the above workload required 14 full-time equivalents (FTE) of technical personnel. Autoverification was expected to reduce the FTEs necessary for this process. Autoverification setup and implementation required 2 FTEs in personnel over a period of 6 weeks. Automated chemistry assays were chosen for the initial autoverification attempt for several reasons, including high test volume, clearly defined reference ranges and delta checks, ability to define intermediate ranges for abnormal results, and the flagging capabilities of various automated analyzers. Urinalysis was included for the autoverification setup based on the availability of interfaced automated analyzers (IRIS 939 Udx) with which decision rules could …