What do physicians tell laboratories when requesting tests? A multi-method examination of information supplied to the Microbiology laboratory before and after the introduction of electronic ordering

Georgiou, Andrew; Prgomet, Mirela; Toouli, George; Callen, Joanne; Westbrook, Johanna I.

doi:10.1016/j.ijmedinf.2011.06.003

Cited by 16 publications

(14 citation statements)

References 18 publications

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“…(520/6018) of isolates had the sample site information missing, which is similar to human [37,38] and other veterinary studies [39] where information was commonly missing from diagnostic submission forms.…”

Section: Accepted Articlementioning

confidence: 63%

Antimicrobial resistance in clinical bacterial isolates from horses in the UK

Isgren

Williams

Fletcher

et al. 2021

Equine Veterinary Journal

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Background: Surveillance of antimicrobial resistance (AMR) in horses is important to aid empirical treatment decisions and highlight emerging AMR threats. Objective: To describe the AMR patterns of common groups of bacteria from clinical submissions from horses in the UK during 2018, and to determine how this varies by sample site and type of submitting veterinary practice. Study design: Prospective observational study. Methods: All data on bacterial culture and subsequent antimicrobial susceptibility testing (AST) collected in 2018 from six large equine diagnostic laboratories were included. Resistance patterns were analysed including resistance to 1 or 2 antimicrobial classes, multidrug resistance (MDR), extensively drug resistant (XDR), resistance to highest priority critically important antimicrobials and isolates where there was no readily available treatment for adult horses in the UK. Submitting practices were classified according to whether they treated referral cases or not (first opinion). Comparisons between proportions and resistance for each bacterial group and sample site was performed using Chi squared (or Fisher's exact test). Results: A total of 6018 bacterial isolates from 4038 diagnostic submissions were included from respiratory (n=1555), urogenital (n=1010), skin/hair/wound/abscess (n=753), surgical site infection (SSI) /catheterrelated-infection (CRI) /orthopaedic infections (n=347) and unknown/'other' submissions (n=373). There were 2711 Gram-negative isolates and 3307 Gram-positive isolates. Prevalence of MDR for E. coli was 31.7%, Staphylococcus spp. 25.3% and >25% for the majority of bacterial isolates from SSI/CRI/orthopaedic submissions. For Enterococcus spp. there was no readily available treatment for adult horses in the UK in 30.2% of positive submissions. MDR was significantly higher from referral hospital than first opinion submissions for the majority of pathogens (except Actinobacillus spp. and Pasteurella spp. and β-haemolytic Streptococcus spp.). Main limitations: Since culture and susceptibility results are not systematic analyses based on harmonised methods, selection bias could impact the findings. Conclusions: Ongoing surveillance is essential to understand emerging patterns of resistance. MDR is high in SSI/CRI/orthopaedic infections, which is important for hospital biosecurity and guiding treatment decisions. Harmonisation of diagnostic procedures and interpretation of results amongst veterinary laboratories will improve AMR surveillance and data comparison amongst laboratories.

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Section: Accepted Articlementioning

confidence: 63%

Antimicrobial resistance in clinical bacterial isolates from horses in the UK

Isgren

Williams

Fletcher

et al. 2021

Equine Veterinary Journal

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“…5 Electronic requesting has the potential to save money for the NHS by reducing the repeat requests created when the original sample was noncompliant. However, we are aware that the system is not perfect and errors will continue to occur.…”

Section: Discussionmentioning

confidence: 99%

“…It can be used to educate users at the time of sample collection, using specific messages and ensure sufficient information for the interpretation of the tests requested is supplied by the requesting clinician. 5 We aimed to show that the introduction of an electronic order communication system in Primary Care has reduced the number of pre-analytical errors and improved the quality of information received.…”

Section: Introductionmentioning

confidence: 99%

The effect of electronic ordering on pre-analytical errors in primary care

et al. 2013

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“…EHRs often have limited ability to require the ordering physician to answer necessary questions regarding patient history. 30 History for appropriate microbiology testing can be crucial and extensive (travel, immune status, pets, transplant status, occupation, etc), and this information is usually buried within EHR notes rather than being presented in searchable data fields that can be viewed in either the EHR or the CPLIS at the time of culture to assist with appropriate culture and serologic test selection. Appropriate clinical and historical information would also be useful to incorporate into interpretive algorithms, as this would help prevent misguided treatment and overlooking important microbes.…”

Section: Special Considerationsmentioning

confidence: 99%

Management of Laboratory Data and Information Exchange in the Electronic Health Record

Wilkerson

Henricks

Castellani

et al. 2015

Archives of Pathology & Laboratory Medicine

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In the era of the electronic health record, the success of laboratories and pathologists will depend on effective presentation and management of laboratory information, including test orders and results, and effective exchange of data between the laboratory information system and the electronic health record. In this third paper of a series that explores empowerment of pathology in the era of the electronic health record, we review key elements of managing laboratory information within the electronic health record and examine functional issues pertinent to pathologists and laboratories in the exchange of laboratory information between electronic health records and both anatomic and clinical pathology laboratory information systems. Issues with electronic order-entry and results-reporting interfaces are described, and considerations for setting up these interfaces are detailed in tables. The role of the laboratory medical director as mandated by the Clinical Laboratory Improvement Amendments of 1988 and the impacts of discordance between laboratory results and their display in the electronic health record are also discussed.(Arch Pathol Lab Med. 2015;139:319-327; doi: 10.5858/arpa.2013-0712-SO) L aboratory information systems (LISs) are designed to meet workflow needs within the laboratory as well as interface with electronic health record (EHR) and billing systems. Configuration and maintenance of appropriate communication between an LIS and an EHR are very much institution dependent and beyond the scope of this document; however, understanding the complexity of the problem is not.Although anatomic pathology (AP) and clinical pathology (CP) specimens, workflows, and results reporting share many common electronic communications issues, the complexity of the LIS-EHR data flow problem is increased as AP and CP each also have unique information management requirements. Most institutions will have an AP LIS (APLIS) to handle data and workflows related to testing of surgical and cytology specimens, as well as a separate CP LIS (CPLIS) to facilitate testing and reporting of blood and other specimen types. In an attempt to more effectively address these complexities, we will first examine shared issues and then explore issues unique to each type of system. ISSUES SHARED BETWEEN APLIS AND CPLIS Patient IdentificationPositive patient identification is essential at every step of the care life cycle, from the time a patient presents to a clinic through ordering, phlebotomy or biopsy, testing, result transmission, result review, billing, and taking action based on a result. Unique patient identifiers that always associate patient identity with the correct patient data are a crucial problem that has not yet been successfully addressed by legislation. This association is critical when an LIS transmits patient data across multiple institutional, office, health information exchange, and personal health records, as well as state and federal registries for mandatory reporting (eg, communicable infectious diseases for population su...

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What do physicians tell laboratories when requesting tests? A multi-method examination of information supplied to the Microbiology laboratory before and after the introduction of electronic ordering

Cited by 16 publications

References 18 publications

Antimicrobial resistance in clinical bacterial isolates from horses in the UK

Antimicrobial resistance in clinical bacterial isolates from horses in the UK

The effect of electronic ordering on pre-analytical errors in primary care

Management of Laboratory Data and Information Exchange in the Electronic Health Record

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