Pre-analytic stage of the laboratory process

At this pathology service, there are two methods by which a pathology test order can be created. The first uses a handwritten paper test order form on which patient demographic data (e.g., name and date of birth) the tests, and relevant clinical details are recorded by the ordering clinician. This test order form must be signed by an authorised clinician before it is sent to the pathology service with the specimen. The second method of ordering pathology tests is electronic, via the EMR system. The clinician is required to complete the pathology order at a computer terminal and then print a hard copy of the test order form which is sent to the pathology service with the specimen. Specimens may be collected by clinicians directly, or by laboratory phlebotomists during their regular twice-daily blood collection rounds through the wards. Printed test order forms from the EMR use an electronic signature for authorisation. Any subsequent alteration of this printed form, such as the addition of handwritten information, is considered to be unauthorised. If further tests are required after the form is printed a new order must be created.

All test order forms and specimens are received in CSR where they are time-stamped by CSR staff to register the time of receipt. Patient and specimen details are then cross-checked. Figure 1 provides a schematic diagram of the entire CSR workflow process. A LIS-linked barcode (associated with a new test order episode within the LIS) is added to the form, which is then converted into a digital image and archived using an optical scanner. Test order forms and specimens are then transferred to the CSR data entry work area. Laboratory order forms for electronic orders contain at least three barcodes: i) a unique barcode for patient details; ii) unique barcodes for each test (linked to the EMR) and iii) a test order episode barcode (linked to the LIS). Laboratory order forms for paper orders contain only the test order episode barcode (linked to the LIS). In the case of electronic orders, the LIS-linked test order episode and EMR-linked patient detail barcodes are scanned to retrieve those data. A scan of any of the EMR-linked barcodes will provide a complete list of all the tests ordered in that test order episode. For paper orders, the LIS-linked test order episode barcode is scanned electronically but the remaining information (patient details and the list of tests ordered) must be manually typed into the computerised LIS data entry form. The time-stamp of specimen arrival in the CSR must still be entered manually into the computerised LIS data entry form, for both electronic and paper test orders. Once the data entry process is complete, test order forms are sent for archive and the specimens are delivered to the relevant pathology department for processing and analysis.



Figure 1 provides a schematic diagram of the entire central specimen reception workflow process