01 - Misadventures with the Lab

Shari Welch, MD, FACEPShari Welch

According to the CDC a full third of ED patients will have some laboratory testing done as part of their ED visit. Though laboratory testing can cause waits and delays due to operational failures, few departments have worked to address these common failures in a systematic way. The more common failures relative to lab performance fall into the following categories and involve the ED/Lab interface:

  1. Unlabeled Specimens/Mislabeled Specimens
  2. Lost Specimens
  3. Contaminated specimens
  4. Collection Delays
  5. Delays in Results Review

There are a number of key concepts which can be applied to improve lab functioning for the ED. First, lab operations must not function as they often do, by intuition. All work relative to lab testing must be clearly articulated and assigned. Who will draw, label, collect, send and track laboratory specimens? All steps must be monitored for process failures. What is a process failure for a troponin? More than fifteen minutes to be drawn? More than thirty minutes for results to be returned? Below are key concepts for reliable and efficient laboratory processes in the ED:

Efficient, Safe Lab Processes: General Concepts

  • Every task requires clear ownership
  • Every process requires clear articulation
  • Every process should have a time limit
  • Every process should have a measurable failure rate
  • Limit the number of people in the process
  • Labels follow patients ? from patient to specimen
  • Use lean tools and look at process for streamlining
  • One lost or mislabeled specimen is a catastrophe!

Applying these general concepts should get you on the road to improvement in this area. According to VHA and the Abaris Group, consulting firms that focus on high performance in the ED, specific practices have been identified as best practices for lab operations. These practices are listed below:

Best Practices: Lab  

  • Point of Care Testing
  • Bar Coded Labeling
  • ED Based Lab Tech
  • Tube System
  • Lab Draw and IV Start Simultaneous
  • Color Coded ED Specimens
  • Cueing for Results
Feedback
Click here to
send us feedback