Laboratory test order errors

Our retrospective audit of the error log compared the number and frequency of errors logged during the first half of 2009 (when it was a paper based system), and the period between 1 March 2010 and 9 October 2011 (when it was a computerised system). There was a major increase in the number and frequency of errors logged in the system when measured as a rate per 1000 test order episodes increasing from 9.66 in 2009 to 12.67 in 2010 and 13.48 in 2011. The great majority of errors responsible for this increase were attributable to new or changed processes associated with the introduction of EMR, which included errors categorised as “Other,” “No specimen received,” “Test set” and “EMR test order problem.” Closer analysis of the “EMR test order problem” errors revealed that 66.72% of cases were related to an alteration made on a print-out of an electronic test order where a new test order should have been created. Other reasons included the presence of duplicate forms, add-on tests, or an incorrect EMR order.

A cross-sectional analysis of the error log data comparing paper test orders with EMR test orders across the three years found that the rate of errors recorded in the IIMS (for the categories “Mislabelled specimen”, “Mismatched specimen” and “Unlabelled specimen”) were significantly fewer for EMR orders than for paper orders. The findings across categories related to efficiency and effectiveness (e.g., “Accident to specimen; “Insufficient specimen” and “Patient detail problem”) were variable. Process maps were utilised to identify the source of errors recorded as “EMR test order problem” and to help quantify their impact on laboratory processes. Our analysis showed that the median turnaround time (from receipt at the CSR to test result) of test orders with an “EMR test order problem” was 181 minutes (3 hours) longer than the equivalent median for all test order episodes.