Data from the paper-based CSR error log were collected for a six-month period prior to the introduction of the computerised CSR error log (January to June 2009) and were compared longitudinally with matching periods after the implementation of electronic ordering (January to June 2010 and 2011; using data from the computerised error log). The cross-sectional analysis of the computerised error log covered the period from 1 March 2010 (the date that “EMR test order problem” became available as an error category) until 9 October 2011 (the last date before data extraction was performed). Scanned images of test order forms were also available for confirmation of error details. An experienced member of the research team (a laboratory manager/researcher) audited and analysed the error log categories in consultation with senior staff in the pathology service. Over an eight month period (August 2011 to March 2012), 20 meetings were held with CSR staff (supervisor, assistant supervisor and data entry staff) to generate a process map of the workflow process, and to investigate the differences between processes used for paper and electronic test order forms in the processing of errors. Regular iterative feedback sessions were held with senior staff to confirm the validity of the findings.
The error details field in the paper-based and computerised error logs were used to confirm (and adjust if necessary) the classification of errors into the correct categories. Errors were considered as incorrectly classified in cases where the free-text entered in the error log could not be plausibly connected with the chosen error category. Examples of such misclassification of errors are shown in Table 4, for example, where a “Mislabelled specimen” error had been incorrectly classified in the “Other” category. In the case of the paper-based error log, no discrepancies were found between the error category and error details fields for any of the errors, so no reclassification was required. In the case of the computerised error log, for the period of the main cross-sectional analysis (1 March 2010 to 9 October 2011), a total of 7825 errors were logged for test orders coming from the three hospitals (A, B, and C). Of these errors, 947 (12.10%) were classified as “Test set” or “Other” errors; categories often used when an error could not be classified in a more specific category. The classification of 338 (35.69%) of these errors was judged to be inconsistent with the information provided in the free-text details field of the error and were reclassified. A subsequent detailed inspection attempted to reclassify the 553 (58.39%) “Test Set” or “Other” errors that contained no additional information in the free-text details field. For each of these errors, the scanned image of the original test order form was retrieved from the digital archive and was visually inspected for additional information that might inform the error type classification. Based on information found in the associated test order form, 86 errors (all from the “Other” error category) were reclassified, 59 (68.60%) of these errors were associated with a clinician making a handwritten amendment to a printed copy of an EMR order.
|Original category||Error details||Reclassified category|
|Other||Mislabelled specimen||Mislabelled specimen|
|Other||Hand written tests||EMR test order problem|
|Other||Specimen not on ice||Collection requirements|
|Other||No specimen received||No specimen received|
|Test set||Green swab received||Collection requirements|
Table 4. Examples of how the re-coding criteria were applied to the error categories
A test order episode refers to a single occasion where a clinician orders one or more pathology tests involving one or more pathology departments. By expressing the number of errors as a proportion of test order episodes, i.e., as a rate, it is possible to control for the volume of test orders being processed at any particular time or by a particular system (i.e., paper vs. electronic orders).