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Saturday, April 8, 2017

Revising the Laboratory Path of Workflow



Revising the Laboratory Path of Workflow
The concept of a medical laboratory path by which samples are collected and transported and worked upon and information in the form of a report has been around for a long time.  My first recollection was John Meyer’s cartoon in Raymond C Bartlett’s brilliant book Medical Microbiology : quality cost and clinical relevance first published in 1974.  (With interest, MM:QCCR is still available for purchase on Amazon for $1836.24 CAD!)
Meyer’s is more entertaining, but this is my version.
   
                                          

More recently this has been condensed to a more simple and linear arrow with three phases depicted: pre-examination, examination, and post-examination.  The arrow can be made more useful when the three phases are understood to range in relative importance depending on context in which the POW is being considered.  From a Logistic perspective all phases are essentially equal, but in terms of Error Detection, the Examination phase is relatively the minor consideration, while in terms of Clinical Relevancy (recording and reporting of clinically relevant information) the Pre-examination is the least impacting phase. 

In my particular area of interest, Proficiency Testing (PT) or External Quality Assessment, the variable arrow model reminds us that if we look solely at the Examination phase for PT/EQA challenges we miss testing a lot of areas of considerable importance.

But even more importantly there are events that are important in the laboratory but not along any part of the circular or linear POW that are nonetheless important considerations for PT/EQA in the modern era.  

They may or may not directly contribute to the traditional view of generating patient information, but they are critically important.  These are the issues of Safety, and Ethics, Risk management and SOP development and enactment of human error.  

These are NOT part of the POW but the SURROUND the POW.  For the sake of keeping them connected to laboratory terminology, i have taken the concept of surrounding and created a NEW term the PERI-EXAMINATION practices.  So now we can think of PRE-Examination, Examination, POST-Examination and PERI-Examination.  






In a recent presentation I talked about this as a new approach to PT/EQA making the point that we now have the tools to examine all four phases of laboratory life.


Four Phase PT/EQA















I have mentioned our Paper Challenges before as a method of creating text based scenario to challenges laboratories on pre- and post- examination topics.  They are generally liked and effective.  Video Challenges extent this for PT EQA challenges by replacing the text challenge with short .wma files that are easily seen across our network. They depict aspect of laboratory process that may or may not result in immediate error, but increase Risk.  
 Video challenges greatly extend our ability to provide PT/EQA challenges far beyond the traditional walls.  And laboratory workers seem to really enjoy them.  

We have a solid and appropriate concept.  We have the mechanisms and the means to do this extended challenging,  We can successfully argue that the extended testing will provide better insight into laboratory collection, testing reporting and supporting phases.  

The argument is compelling.

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