Real-Time Critical Lab Alerts

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by albert1g3
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Real-Time Critical Lab Alerts

❖ Current practices of reporting critical laboratory values make it challenging to measure and assess the timeliness of receipt by the treating physician as required by The Joint Commission’s 2015 National Patient Safety Goals (Parl et al., 2010, p. 417).❖ Critical results of tests and diagnostic procedures fall significantly outside the normal range and may indicate a life- threatening situation. The objective is to provide the responsible licensed caregiver these results within an established time frame so that the patient can be promptly treated ("Joint Comission," 2015, p. 2).❖ Hundreds of hospitals, on a number of occasions have endured from litigations due to the failure of not responding, in a timely manner, to laboratory notifications involving life-threating situations (Young, 2011, p. 14). Critical value reporting is an important practice in all hospital settings and is a regulatory requirement by The Joint Commission.❖ In order to acclimate and improve upon current system technology, a superior laboratory efficiency and physician communication tool is needed. ❖ Real Time Critical Lab Alerts (RTCLA) is an essential technological movement in healthcare that alerts responsible professionals within the medical field in a timely manner of laboratory results for patients whose lives may be in danger. RTCLA reports critical values via the laboratory and hospital information systems to alphanumeric pagers, ipads, iphones, electronic mobile devices, handheld tablets, or any other device that is made for portability. RTCLA communicates with physicians and ensures failsafe notification, instant documentation, automatic tracking, escalation, and reporting of critical value alerts. ❖ The target organization is an internationally recognized, academic health system in Miami FL with a specific focus on Trauma Patients. The Trauma Intensive Care Unit (TICU) is composed of 25 beds, 5 of which are dedicated to critical burn patients. The multidisciplinary staff consists of trauma physicians and surgeons, trauma residents, nurse practitioners, registered nurses, respiratory technicians, unit secretaries, and radiology technicians.

❖ Streamline Reporting ❖ Automatic Population of Patient Record❖ Document Log❖ Audit Trail with Proof of Compliance❖ Paperless Directory ❖ Wifi, Tablets, Smart Phones, Portable Devices, Chargeable Docking Stations❖ Closed-loop Communication❖ Improve laboratory efficiency and physician communication❖ Decreased Physician Notification Time❖ Decreased Manual Notification Effort ❖ Documentation of Every Time Point in the Reporting Pathway

❖ The organization is strongly committed to supporting the RTCLA system. ❖ An initial investigation was conducted to determine the needs of the facility in regards to reporting of critical lab values. Researchers identified current deficits in the lab reporting system and turned to developers for possible suggestions. This in turn allowed the system to be developed specifically for the hospitals needs and provide clinical usefulness. Jian et al. (2012) conducted similar tests prior to the implementation of an automatic SMS alert system of lab results. Conducting research prior to implementation allowed for a tailored system to be created and decrease future obstacles that would be faced. ❖Diffusions of Innovation Theory: human interaction through interpersonal networks.❖ Phased approach to allow the idea to spread from unit to the next. ❖Mentors❖Obstacles: Difficulty understanding how to use the system, negative attitudes, unwillingness to change.❖Change agents, opinion leaders, and change aides will be used overcome obstacles. ❖The stages through which a technological innovation passes are: knowledge, persuasion, decision, implementation, and confirmation. Knowledge will be provided to employees by handouts and staff meetings to form favorable attitudes ❖The system will be implemented in phases so it can be tested for possible errors and revamped as necessary. ❖Confirmation will be done after the system is implemented and positive outcomes have been achieved (Clarke, 2015).

❖ Next-generation clinical alarm systems are available to a limited market and designed to accommodate a workflow that provides expedited results with context that leads to improved situational awareness. ❖Extension Engage: a unified clinical alarm notification system capable of efficient delivery of critical lab reports with contextual information regardless of physician location (Extension Healthcare, 2014, p. 2) ❖Spok Inc. (previously named Amcom) is a critical test results management software program that can significantly reduce costs and save valuable time while improving patient care and reducing litigation costs (SPOK, 2014, p. 2).❖With regards to RTCLA software technology initiatives, out of the two possible solutions available, Spok software was chosen with the intention of truly impacting the current target organization in Miami Fl.Products that are available:❖Electronic solutions are currently available to meet the needs of RTCLA❖Introduction of smartphone Mobility Solutions❖Spok Software❖Laboratory Information System Interfaces❖Requisition and Label PrintersSupported Literature:❖Computerized reporting of critical values through the use of portable device initiatives meets accreditation and clinician requirements with capabilities to increase patient safety and satisfaction (Piva, Sciacovelli, Zaninotto, Laposata, & Plebani, 2010, p. 441).


Functional Requirements

Real-Time Critical Lab Alerts (RTCLA)

Introduction and Organizational Description

4 months is the desired time frame from purchase to hospital wide implementation. Phase 1 /Pilot Study= 1 month, Phase 2= 1 month, Phase 3= 2 monthsRisks Associated❖ Disruption of Usual Lines of Communication❖ Violation of Patient Privacy Rights❖ Physicians not Acknowledging Critical Lab Values❖ System Malfunctions(CDC, 2012)Steps to Mitigate Risks❖ Risk Identification and Assessment ❖ Manual Procedures and Training to Users❖ Strict Protocols regarding actions to take when Physicians do not respond❖Training that Highlights HIPPA Laws❖Progress Monitoring❖Usability Testing(CDC, 2012)

Planning Implementation

Please see attachments for full reference list.

Organizational Readiness

❖ Researchers estimate that U.S. hospitals waste more than $12 billion annually from communication inefficiencies, and a 500-bed hospital is estimated to lose more than $4 million per year. Of that amount, increased length of stay accounts for 53 percent (TJC Sentinel Events, 2014).❖ In the course of evaluating quality and safety performance results over a 10-year period, The Joint Commission consistently found communication to be among the top three leading root causes of sentinel events (unanticipated events resulting in serious injury or death) ("Spok," 2014, p. 3)

Current Workflow Analysis

❖ Participation of key stakeholders is recommended to enhance buy-in from personnel and to help ensure the programs feasibility and sustainability (Singh & Vij, 2010, p. 226).Who will be impacted?❖ Key stakeholders will include providers (both primary care and subspecialists), registered nurses, laboratory personnel, radiologists, quality improvement personnel, respiratory technicians, IT staff, corporate leaders, and residency training program personnel. ❖ Initial hesitation is expectedEnd Users❖ End users include all individuals who have first line access to the RTCLA technology system. - Physicians (both primary care and subspecialists)- Nurses- Laboratory Staff- Hospital Operator - Allied professionals (those who are behind the scenes (IT specialist, software technicians) Diffusion of Innovations Theory❖ Stakeholders and end users are categorized into specific roles based on The Diffusion of Innovations Theory, which describes the process by which new ideas and initiatives are implemented into a society or organization (Andrews, Tonkin, Lancastle, & Kirk, 2014, p. 880).❖ Physicians, nursing supervisors, and nurses are selected as early adopters❖ Hospital operators, laboratory technicians and allied health professionals are selected to be apart of the early majority.



❖ Development of a testing plan ❖ Software testing to identify system glitches, software bugs, and design errors.❖ Controlled environment: 10 nurses and 5 physicians with virtual data from simulated patient information❖ 1 month testing in the Trauma ICU after specialized training will serve as the pilot study❖ User feedback surveys and debriefings❖ If pilot study is successful it will be moved forward to other units


Frida Iturriaga & Alberto GonzalezNGR 7871Florida International University


❖ Callahan (2014) lists training failures as one of the top three reasons laboratory reporting systems fail.❖ Special emphasis on training staff over 1 full day. ❖ Testing in 3 phases ❖ Phase 1: The system will be implemented in the Trauma ICU. ❖ Issues will be identified and solutions will be designed (Pilot phase) ❖ Phase 2: The redesigned system will be implemented in all ICUs. User feedback will be ascertained along with system issues and redesigns will be configured. ❖ Phase 3: Hospital wide system implementation ❖ Implemented in phases so that each phase can be used for the next phase to build on. This allows for: identification of issues, redesigns, user feedback, and a smoother implementation once the system is launched hospital wide.

Organizational Readiness Training


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