In my previous post in this two-part series, I talked about how software can support your analysts as they follow your laboratory’s standard operating procedures (SOPs). This time, let’s take a closer look at how software that closely matches your SOPs can help your lab reduce errors, enhance morale, and improve patient safety.
Two ways to view errors made in the lab
When it comes to errors in the lab, there are two paradigms for evaluating them. The “person approach” asserts that humans are responsible for errors due to fatigue or carelessness, whereas the “systems approach” attributes errors to faulty systems.
At Semaphore, we firmly believe the second approach is more constructive. If lab software is well-designed and built with the right checks and balances, it can help detect and prevent human errors.
When an error does occur, rather than blaming staff, which can lead to potential shame and subsequent under-reporting of future errors, labs should focus on implementing changes to the system to ensure errors don’t happen again. This approach is much better for morale and puts the lab in a better position for addressing errors.
Errors in the laboratory diagnostic cycle
The complexity and variety of processes involved in a laboratory diagnostic cycle, or total testing process (TTP), make it very likely that errors will occur, and these errors can be ambiguous and difficult to pinpoint.
The TTP is made up of three phases—pre-analytical, analytical and post-analytical—each with the potential for errors to occur.
Traditionally, it involves manually intensive processes, such as:
- A clinician orders a test.
- A technician collects a sample.
- A courier picks up and transports the sample.
- The lab processes the receipt of the sample.
Furthermore, during this phase, critical details are manually recorded, including patient data and the sample collection time. Plus, the sample integrity and stability must be maintained so that it reaches the lab in good condition.
It’s estimated that 60–70% of errors affecting lab results occur in the pre-analytical phase.
This phase of performing the actual diagnostic tests occurs within the lab environment. While analytical errors have been reduced drastically in recent years, there’s still a need to further improve quality within the lab.
This reporting phase is also typically outside the lab. One study reported that misinterpretation of diagnostic results accounts for about 37% of errors in the clinical setting.
Considering errors across all three phases, one study reported a distribution of 61.9% in the pre-analytical phase, 15% in the analytical phase, and 23.1% in the post-analytical phase. This might seem like good news for labs primarily responsible for the analytical phase, but errors at any stage of the TTP may have a negative patient impact and should be investigated.
How to reduce errors
The single most common human error is probably the omission of a necessary step during a particular task. A strategy to combat this type of error is to use physical reminders, such as sticky notes, notebooks, and checklists. But even these paper-based systems are prone to failure. What happens when a sticky note loses its stickiness and falls to the floor?
A better approach is to build software that guides analysts through a procedure. In our experience, building the software UI to explicitly support your SOPs is a worthwhile undertaking. That’s because it helps analysts perform all the necessary steps during an analytical test and in the right order. For example, one project implemented an electronic safety checklist software program that helped prevent errors for radiation therapy—welcome news for patients receiving the therapy.
Another way to reduce errors during the manually-intensive pre-analytical phase is to implement SOPs for each step—patient identification, sample collection and handling, and specimen acceptance or rejection. This ensures clinical staff follow a specific checklist when performing pre-analytical tasks.
To help with the post-analytical phase, you can integrate analytical instruments with your LIMS or LIS to avoid data transcription errors, or use a custom reporting application to streamline report delivery to the ordering physician.
If your lab handles samples from multiple sources, you might consider using a custom order management portal to centralize all these orders. The primary goal is to eliminate as many manual steps as possible through automation and adopt a continuous improvement process.