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1The University of Texas School of Biomedical Informatics at Houston, Houston, TX
2Department of Internal Medicine...
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Improving Lab Order, Verification, and Follow-up Processes at UT Physicians

We retrieved electronic health record data on lab order, verification, and follow-up processes at UT Physicians and developed a dashboard to describe metrics for evaluating these processes. A two-month pilot evaluation of one department indicates some room for improvement in standardizing and improving processes to improve quality of care, patient safety, and satisfaction.

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Improving Lab Order, Verification, and Follow-up Processes at UT Physicians

  1. 1. Methods 1The University of Texas School of Biomedical Informatics at Houston, Houston, TX 2Department of Internal Medicine, 3Physician Business Services, The University of Texas Medical School at Houston, Houston, TX Allison B. McCoy, PhD1, R. Priya Khatri, MBA, MPH2, Lindy J. Anderson3, Rachel B. McDade3, Dean F. Sittig, PhD1, Eric J. Thomas, MD, MPH2 Improving Lab Order, Verification, and Follow-up Processes at UT Physicians Objective Summary of Conclusions Acknowledgements Reliable lab order, verification, and follow-up processes are necessary for safe care and caregiver and patient satisfaction. As part of the University of Texas System Systems Engineering in Healthcare Initiative, we sought to standardize and improve these processes in order to reduce costs and improve quality of care, patient safety, and patient and clinician satisfaction. EHR data was useful in identifying and evaluating current lab order, result, and verification processes. Some room for improvement was identified in the processes, including reducing errors that lead to results needing to be merged and decreasing time to verification of lab results. Next steps include identification and implementation of interventions to improve these processes to improve quality of care, patient safety, and satisfaction. This project was supported in part by The University of Texas System’s Systems Engineering in Healthcare Initiative and NCRR Grant 3UL1RR024148. Please contact the first author via email: amccoy1@tulane.edu We reviewed current practices and began identifying areas for improvement using Six Sigma methodology in lab order, verification, and follow-up processes at UT Physicians, a large, multi-specialty, ambulatory practice in Houston, TX. We extracted electronic health record (EHR) data from our clinical data warehouse. When possible, we verified retrieved data through EHR walkthroughs and clinician shadowing. We then developed a dashboard to summarize the data and present relevant lab-related metrics, such as number of orders entered electronically, number of orders with results, and time to physician verification of resulted labs. Systems Engineering Tools Dashboard •Re-train MDs on order procedures •Remove paper lab order forms from clinic •Create training video for attendings, residents, and clinical staff •MD/RN provides directions to lab •Set patient expectations regarding timing of lab result follow-up and method •Re-train MDs and residents on verification procedures •Goal: 7 days to verify labs The following interventions are designed to improve the entire process: •Dashboard distribution to administrators and MDs •Encourage selection of Hermann as lab of choice •Back up process for verification and patient follow up when MD is away •Set roles and responsibilities for attendings, residents, RNs, and MAs Define •Create process and expectation for patient follow up (timing and method) •Set goal: # days for patient follow up after verification Project Charter • Goals • Scope • Team Identification High Level Process Map Critical to Quality (CTQ) Identification Control and Replicate Control Charts Dashboards Roll out of new training plans and SOPs to other departments Measure Baseline Data Collection Value Stream Maps Detailed Process Maps Fishbone Diagram Identification of Critical Xs Root Cause Analysis Analyze Performance Analysis Improve Pilot Testing Creation of new training plans and SOPs MD/RN evaluates patient, identifies lab orders needed, enters information into EHR User enters information into EHR Lab processes order information, performs test, and sends information to EHR Attending forms diagnosis and/or next steps MD/RN informs patient of results and next steps Lab Order, Verification, and Follow-up Processes with Proposed Interventions

We retrieved electronic health record data on lab order, verification, and follow-up processes at UT Physicians and developed a dashboard to describe metrics for evaluating these processes. A two-month pilot evaluation of one department indicates some room for improvement in standardizing and improving processes to improve quality of care, patient safety, and satisfaction.

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