The Use of LIS-Interfaced Barcode Technology to Reduce Preanalytical Errors

Introduction

Naval medical analysis accessories (MTFs) can accept assertive technologies to aid in abbreviation preanalytical errors. These errors abuse the affection of accommodating affliction by deferring its commitment or creating cher inefficiencies. The preanalytical action entails all procedures alpha from sample accumulating to back the sample can be analyzed by a processing class (Lippi et al., 2013). Unsurprisingly, the aggregate of preanalytical errors action alfresco of the accepting class and nearer to the point of collection, such as aural clinics or inpatient wards. They may accommodate mislabeled samples, inappropriate accumulating procedures, or samples beatific to a processing class after requisite physician orders. Though the causes of preanalytical errors are numerous, the consistent aftereffect is monolithic; that is, the amount of bloom affliction commitment increases while bloom affliction affection diminishes.

A Analysis of NMCSD

In the face of such “man-made” challenges, the Argosy Medical Center San Diego (NMCSD) is no added allowed than the dozens of MTFs that dot the abutting landscape. Indeed, as the medical hub of the western seaboard, accepting over 1.2 actor outpatient visits in 2014 alone, NMCSD has few equals aural the accomplice of MTFs (Naval Medical Center San Diego, 2016). Accordingly, action and abstruse improvements are bounden to its mission of accouterment optimized affliction to the aggressive community. To this end, I will analysis how the use of barcode scanning technology can abate the cardinal of preanalytical errors stemming from a abortion to ascribe provider orders afore a case is transported.

The Sample Accumulating and Processing Process

The action of sample accumulating and carriage at NMCSD differs little from alternative aggressive MTFs. To begin, a accommodating is checked-in by medical cadre and after transported to a analysis breadth (Figure 1). There, appraisal occurs, and exact orders may be accustomed to acquaint sample accumulating procedures. Afterward this, barcode labels absolute accommodating identifiers are generated and added to the samples, afore actuality transported to the class for processing. 

At assorted credibility in this process, preanalytical errors can occur. To activate with, if exact (not written) orders are given, which generally occurs during emergencies, inappropriate samples ability be calm as a aftereffect of the misunderstandings and assumptions that appear (Lippi et al., 2013). In addition, barcode-generated labels may be added to the amiss sample, or samples transported to the class afore orders are ascribe in the class advice arrangement (LIS). Tracking these infractions can be arduous for any MTF, abnormally one as ample and heavily trafficked as NMCSD.  Thus, in ablaze of such challenges, able uses of technology and able-bodied affection affirmation programs are active in optimizing sample processing procedures, while additionally authoritative errors (Lillo et al., 2012). These programs may entail suggesting action improvement, acclimation interdepartmental consortiums that focus on arising challenges, or anecdotic affidavit for trends or recurrences. Moreover, able training in medical procedures and competencies in the use of accessible technology is additionally basic to optimizing healthcare delivery.

Concerning sample processing nearer to the point of collection, the use of barcode scanners that are interfaced with LIS can badly abate the cardinal of preanalytical errors (Pantanowitz & Parwani, 2014). To accept how, accede the afterward not aberrant book aboriginal involving samples that originated from the NMCSD Emergency Department (ED), or to a bottom extent, the accessory inpatient wards. Afterward a accommodating assessment, lab orders may be accustomed verbally appropriately acceptance sample accumulating to action sooner. However, orders not after ascribe in LIS, in beforehand of specimens carriage to the processing laboratory, are not readily articular nearer to the point of accumulating (Figure 1). Thus, the processing class receives labeled barcoded samples but is clumsy to accretion them for case processing, in the absence of provider orders. Consequently, accommodating affliction is delayed, and sample adherence is abnormally impacted, abnormally for added acute class assays. In acknowledgment to these types of scenarios, which action dozens of times daily, the processing class will blast the ED or the area area accommodating appraisal occurred. Exasperating the situation, samples generally admission continuously and may alike beat aeriform tube stations (Lillo et al., 2012). This aggregates efforts to actuate the requesting location. Further, the processing artisan may be altered from the one who delivered the samples from anniversary aeriform station, thereby, complicating accuracy further. Finally, efforts to locate the accommodating application LIS are not consistently abounding due to advice not actuality readily updated, abnormally back patients are transferred amid wards (Snyder et al., 2012). Hence, class technicians become tasked with “figuring out” the patient’s requesting area so that the provider or advice the accessory assistant to ascribe orders in LIS. Meanwhile, the calm samples abide chapped until the orders are entered.

Such inefficiencies and preanalytical errors can be alone if the requesting area verifies orders before case transport. However, computer terminals and aeriform tube arrangement stations are not consistently nearby. Further, the claim of CAC-enabled login at aggressive MTF to admission centralized systems added restricts the terminals that medical cadre can access, and appropriately prohibits able analysis (Snyder et al., 2012). Thus, it becomes easier to accept that the adapted orders are reflected in LIS instead of acceptance if this is absolutely the case. This asperity is added amplified by the actuality that the medical cadre accession the sample may be altered from the provider requesting the labs, who may additionally alter from the actuality carrying the samples to the aeriform tube system.

Installing barcode scanning accessories in terminals interfaced with LIS and in adjacency to aeriform tube arrangement stations can potentially annihilate these scenarios from occurring, and by extension, the preanalytical errors they accomplish (Lippi et al., 2013). Thus, able analysis can appear afterpiece to the point of collection, which will abate the cardinal of samples transported to the class after inputted provider orders. Moreover, discrepancies stemming from the amiss sample blazon calm (e.g., claret samples for tests that crave serum) can bound be articular application the LIS interface aloof afore its busline to the processing class (Snyder et al., 2012). Scanning the barcode of anniversary sample application the added label, and reviewing accommodating identifiers, the lab tests ordered, and case requirements can be calmly visualized by users, consistent in antidotal accomplishments actuality accomplished eventually by those added anon complex in the affliction of the patient. 

As an example, accede the antecedent book involving the Emergency Department samples. If barcode scanning terminals interfaced with LIS were installed abreast aeriform tube stations, the analysis of samples after provider orders would action aural the ED (closer to the point of collection) (Figure 2). At this stage, the medical cadre would locate the accessory assistant or physician and appeal that orders be ascribe – unless of advance the actuality accomplishing the analysis is the accessory assistant or physician (Snyder et al., 2012). Thus, the class aloft cancellation of the specimens can activate processing after delay, adverse the charge to acquaintance the requesting area for affidavit involving missing orders, incorrect sample submitted, and so forth.

The use of barcode scanning technology is already all-over aural the American association including in grocery store, pharmacy, and hospital settings. Moreover, the technology is additionally activated by the NMCSD Main Class to browse samples delivered through the aeriform tube system. Thus, adapting this technology for use aural the assorted requesting locations that consistently carriage samples to the class would abate the cardinal of preanalytical errors that action in aggressive MTFs including NMCSD. Moreover, the accompanying costs of purchasing, installing, and advancement the technology can acceptable be recovered in the anatomy of decreases in the breadth of hospitalization, increases in class productivity, and alternative improvements in the access of bloom affliction commitment (Snyder et al., 2012). 

Conclusion

NMCSD and alternative aggressive MTFs angle to account from adopting LIS-interfaced, barcode scanning technology. By installing LIS accurate terminals outfitted with barcode scanning technology in adjacency to aeriform tube stations, can accumulate sample analysis and abate preanalytical errors. Thus, the consistent processing delays and inefficiencies that such errors actualize would be bargain if not eliminated. Vigorous analysis and beforehand of absolute processes, and, to that end, leveraging the accurate technology, is ascendant to both the efforts of argosy anesthetic and the Department of Defense at large, in accouterment the greatest affection of affliction to associates of the uniformed casework and their dependents. Thus, we owe it to ourselves and the communities to which we serve, to annihilate the opportunities for errors such as these to occur. Hence, by adopting these action improvements through LIS-interfaced barcode scanning terminals, we account not aloof ourselves but those whose bloom we are answerable with protecting.

References

Chan, J. C. W., Chu, R. W., Young, B. W. Y., Chan, F., Chow, C. C., Pang, W. C., ... & Leung, P. M. (2004). Use of an cyberbanking barcode arrangement for accommodating identification during claret transfusion: 3-year acquaintance in a bounded hospital. Hong Kong Medical Journal, 10(3), 166-171.

Lillo, R., Salinas, M., López Garrigós, M., Naranjo Santana, Y., Gutiérrez, M., Marín, M. D., ... & Uris Sellés, J. (2012). Abbreviation preanalytical class sample errors through educational and abstruse interventions.

Lippi, G., Becan-McBride, K., Behúlová, D., Bowen, R. A., Church, S., Delanghe, J., ... & Nikolac, N. (2013). Preanalytical affection improvement: in affection we trust. Clinical Chemistry and Class Medicine, 51(1), 229-241.

Naval Medical Center San Diego, (2016). Why NMC San Diego? Med.navy.mil. Retrieved 22 March 2016, from http://www.med.navy.mil/sites/nmcsd/pages/visitors/why.aspx

Pantanowitz, L., & Parwani, A. (2014). Practical Informatics for Cytopathology. Springer Science & Business Media.

Snyder, S. R., Favoretto, A. M., Derzon, J. H., Christenson, R. H., Kahn, S. E., Shaw, C. S., ... & Tanasijevic, M. J. (2012). Effectiveness of barcoding for abbreviation accommodating case and class testing identification errors: a Class Anesthetic Best Practices analytical analysis and meta-analysis. Clinical Biochemistry, 45(13), 988-998.

Appendix

Figure 1: Flow Chart--with Barcode Scanner and LIS terminal

Figure 2: Flow Chart Sample Processing

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