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