Enhance the effectiveness of clinical laboratory critical values initiative notification by implementing a closed‐loop system: A five‐year retrospective observational study

Li, Runqing; Wang, Tengjiao; Gong, Liang; Dong, Jianfei; Xiao, Nan; Yang, Xiaohuan; Zhu, Daiyin; Zhao, Zhigang

doi:10.1002/jcla.23038

Cited by 8 publications

(21 citation statements)

References 27 publications

(53 reference statements)

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“…10,11c The difference is we only analyze the laboratory test result from the inpatient ward which has a higher chance to contribute to critical value, whereas the previous study involved the emergency and outpatient departments. 10,6 For the example low platelet count ≤100.000/μL (thrombocytopenia) and increasing hematocrit >20% are the laboratory criteria for hospitalization on DHF cases with clinical symptoms which prone to get critical value in inpatient ward. 14 The hospital target about laboratory critical value reporting yet achieved as they established the target is 100%.…”

Section: Resultsmentioning

confidence: 99%

The importance of hospital re-accreditation: improving the timeliness of laboratory critical value reporting

Febrianto¹,

Rahmawati²,

Sastrawan³

et al. 2021

hsji

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Background: Patient safety is the main issue in healthcare services nowadays. Delaying to inform the critical value of laboratory results is a significant source of harm for the patient. The aim of this study is to compare the timeliness of laboratory critical value reporting before and after re-accreditation as one of the service quality indicators in Hospital X. Methods: This study was done by using observational cross-sectional in Hospital X on January - February 2020 with total sampling method of critical value reporting to the responsible clinician that originated from Intensive Care Unit (ICU), Verlos Kamer (VK), and inpatient ward (IW) 1-6 from January-December 2019. The timeliness of reporting was counted since the laboratory result was obtained until received by the responsible clinician within £ 30 minutes and categorized as "On time" or "Late". Results: During 2019, there were 816 reporting which has been done before re-accreditation (511) and after re-accreditation (305) with 17 kinds of tests. The most reported test was platelet with 349 (before re-accreditation) and 101 (after re-accreditation), whilst SGOT/SGPT and albumin were the fewest one. The lowest timeliness of reporting percentage was 76,00% (February), whilst the highest was 98,48% (November). The timeliness of reporting's percentage was 84,34% (before re-accreditation) and 94,43% (after re-accreditation). The statistical analysis result revealed Pearson Chi-Square correlation was 18,535 with significance 0,000 and 3,145 odds ratio which shows that re-accreditation could significantly increase the timeliness of critical value reporting three times. Conclusion: This result showed that re-accreditation could affect the timeliness of laboratory critical value reporting to the responsible clinicians. Keywords: re-accreditation, critical value, laboratory, patient safety, hospital Abstrak Latar belakang: Keselamatan pasien merupakan isu utama dalam pelayanan kesehatan. Tertundanya komunikasi hasil nilai kritis laboratorium merupakan sumber bahaya yang signifikan terhadap pasien. Penelitian ini bertujuan untuk membandingkan ketepatan waktu pelaporan nilai kritis laboratorium sebelum dan setelah reakreditasi sebagai salah satu indikator mutu di RS X. Metode: Penelitian dilakukan dengan cara observasional dengan metode cross sectional di RS X pada Januari - Februari 2020 dengan total sampling laporan nilai kritis kepada Dokter Penanggung Jawab Pasien (DPJP) yang berasal dari ruang Intensive Care Unit (ICU), Verlos Kamer (VK), dan ruang rawat inap 1 – 6 sejak Januari – Desember 2019. Ketepatan waktu pelaporan dihitung sejak hasil pemeriksaan didapatkan hingga diterima oleh DPJP dalam waktu £ 30 menit dan dinyatakan sebagai "Tepat Waktu" atau "Terlambat". Hasil: Selama tahun 2019, terdapat 816 pelaporan yang dilakukan sebelum akreditasi (511) dan setelahnya (305) dengan 17 jenis pemeriksaan. Pemeriksaan trombosit menjadi yang paling banyak dilaporkan yaitu 349 (sebelum akreditasi) dan 101 (setelah akreditasi), sedangkan SGOT/SGPT dan albumin menjadi yang paling sedikit. Persentase ketepatan waktu pelaporan paling rendah adalah 76,00% (Februari) sedangkan yang paling tinggi adalah 98,48% (November). Persentase ketepatan waktu pelaporan didapatkan 84,34% (sebelum akreditasi) dan 94,43% (setelah akreditasi). Hasil analisis statistik didapatkan korelasi Pearson Chi-Square 18,535 dengan signifikansi 0,000 dan Odds ratio 3,145 menunjukkan re-akreditasi mampu meningkatkan kemungkinan ketepatan waktu pelaporan nilai kritis sebesar tiga kali lipat. Kesimpulan: Hal ini menunjukkan bahwa re-akreditasi mampu mempengaruhi ketepatan waktu pelaporan nilai laboratorium kritis kepada DPJP. Kata kunci: re-akreditasi, nilai kritis, laboratorium, keselamatan pasien, rumah sakit.

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Section: Resultsmentioning

confidence: 99%

The importance of hospital re-accreditation: improving the timeliness of laboratory critical value reporting

Febrianto¹,

Rahmawati²,

Sastrawan³

et al. 2021

hsji

View full text Add to dashboard Cite

show abstract

“…Patient safety is a continuous focus for the joint commission and thus for our laboratory also. 15 The median reporting time of notification to the ICU, emergency, and other inpatient areas was also reduced significantly ( Table 2 ) but communicating the critical value to outpatients and their timely intervention by the responsible care giver is still a major hurdle ( Table 2 ). Li et al had also reported that quality indicators for critical alerts were poor for outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Quality Tools and Strategy for Critical Alerts Process Improvements to Ensure Patient Safety

Jha

Agarwal

2022

J Lab Physicians

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Objectives A number of regulatory and accrediting bodies require the reporting of critical results on a timely basis (immediately or within the time frame established by the laboratory) to “the responsible, licensed caregiver” as timely notification of critical laboratory results can pivotally affect patient outcome. The aim of the study was to decrease the turnaround time (TAT) of critical result notification along with assurance of notification to the concerned caregiver or clinicians. The objectives was 30% reduction in the critical value notification TAT and identify factors associated with delayed reporting and root cause analysis for these factors by application of quality tools. Materials and Methods The study was conducted at the Institute of Human Behavior and Allied Sciences, Delhi, a tertiary center teaching Hospital, from April 2019 to June 2021. A value streamed Process Map of critical alert was prepared. The incidents related to failure were presented through Pareto chart. The possible causes were analyzed through the fishbone model. The failure mode prioritization was executed with Failure Mode and Effect Analysis (FMEA). Through extensive brainstorming, appropriate and feasible corrective actions were implemented. The effectiveness of the implemented plan was analyzed by reassessing the TAT of critical alert and feedback received by clinical caregivers. Results After implementation of corrective action plan using quality tools for 3 months, the average critical alert TAT was reduced to 21 minutes from 30 minutes (30% reduction). The median critical alert TAT for ICU, emergency, and IPD were reduced to 3 minutes (IQR: 1–7). During the pilot project, 156 critical value data were sent for feedback with treatment plan but was received only for 88 patients (56%). Conclusion Comprehensive utilization of quality tools has a potential role in patient safety by reducing the critical alert TAT as well as establishing an effective communication between laboratory personnel and clinicians.

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“…There communication of critical values as essential [14], and our respondents seem to agree. Notification is usually ineffective when contacting the responsible physician by telephone [15]. Telephone notification has advantages according to AlSadah et al [8], such as affording the opportunity to read back the results with immediate explanation, if needed, to minimise errors.…”

Section: Correct Answers Of Upper and Lower Limits And Units Of Criti...mentioning

confidence: 99%

“…Past studies co-ordinated our current results and showed the attitude towards the policies and guidelines regarding critical value notification. Managing the notification time and following a flowchart to report critical values can reduce reporting errors, improve notification of critical values and further guarantee patient safety [15]. Dixon et al [29] stated that result notification should be available in health departments within 1440 to 2880 min.…”

Section: Correct Answers Of Upper and Lower Limits And Units Of Criti...mentioning

confidence: 99%

Baseline assessment of staff perception of critical value practices in government hospitals in Kuwait

ALFadhalah

Mudaf

Tawalah

et al. 2022

BMC Health Serv Res

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Background Notification of laboratory-determined critical values is key for effective clinical decision making and is thus a consequential step in a patient’s health care and safety. This study presents an overview of staff reporting policies and procedures concerning critical values in Kuwaiti governmental hospitals. Methods A cross-sectional descriptive study design was adopted. Study subjects were affiliated with laboratories from five government hospitals (four general and one sub-specialty hospital). All laboratory staff in every hospital were included. The Statistical Package for the Social Sciences (version 23) was used to analyse the collected data at a significance level of ≤ 0.05. Quantitative data analysis included univariate descriptive (means, medians, standard deviations, frequencies, percentages) and bivariate (chi-squared, ANOVA and Kruskal–Wallis tests) analyses. These analyses provided associations between participating hospitals and staff perceptions towards the policies and procedures surrounding critical values. Results 559 questionnaires were returned, a total response of 30.5% after those of 79 phlebotomists were excluded (eligible sample size n = 1833). The notification of critical values differs between participated laboratories in delivering protocol and time duration. Linked protocols between laboratories did not exist regarding policies and guidelines for applying the same procedures for critical value notification. There are differences in critical value limits among the participating laboratories. Conclusion This study is the first to survey laboratory staff perceptions of critical value practices in Kuwaiti government hospitals. Enhancing critical value reporting and policy is crucial for improving patient safety and to develop high-quality health services. The findings of this study can help policy makers implement future intervention studies to enhance laboratory practices in the area of critical values and improve patient safety and the quality of government hospital systems.

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Enhance the effectiveness of clinical laboratory critical values initiative notification by implementing a closed‐loop system: A five‐year retrospective observational study

Cited by 8 publications

References 27 publications

The importance of hospital re-accreditation: improving the timeliness of laboratory critical value reporting

The importance of hospital re-accreditation: improving the timeliness of laboratory critical value reporting

Quality Tools and Strategy for Critical Alerts Process Improvements to Ensure Patient Safety

Baseline assessment of staff perception of critical value practices in government hospitals in Kuwait

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