The organisational and communication implications of electronic ordering systems for hospital pathology services

Computerised Provider Order Entry (CPOE) systems provide clinicians with the ability to electronically enter hospital orders for laboratory tests and services. CPOE is able to integrate with hospital information systems and provide point of care decision support to users thereby making a potentially significant contribution to the efficiency and effectiveness of care delivery. The evidence of the impact of CPOE systems on pathology services is not extensive and insufficient attention has been paid to their effect on organisational and communication processes. This thesis aimed to investigate the implications of CPOE systems for pathology laboratories, their work processes and relationships with other hospital departments, using comparative examinations to identify the tasks they are involved in and the particular needs the laboratories expect to be filled by the new system. This longitudinal study of a CPOE system was carried out over three years using multiple cases from a hospital pathology service based at a large Sydney teaching hospital. Multi-methods using quantitative and qualitative data were employed to achieve triangulation of data, theory and methods. The findings provide evidence of a significant 14.3% reduction of laboratory turnaround times from 42 to 36 minutes when laboratory data for two months were compared before and after CPOE implementation. The findings also reveal changes in the pattern and organisation of information communication, highlighting transformations in the way that work is planned, negotiated and synchronised. These findings are drawn together in a comprehensive organisational communication framework that is highly relevant for developing a contingent and situational understanding of the impact of CPOE on pathology services

Laboratory medicine : a national status report

Although the U.S. ranks highest in per capita health care spending, there is overwhelming evidence of gaps between well-founded standards of care and health care practice. The Institute of Medicine reports, To Err is Human: Building a Safer Health System (1999) and Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and other sentinel studies have focused national attention on improving the quality and safety of health care. Stakeholders agree that the quality of care delivered in the U.S. is inadequate and that the organization and delivery of health care must be improved.Given the shortfalls in quality and continued escalation in costs, health care must be assessed continually to inform decision-making, and redesign delivery and incentives as needed, to yield appropriate, high quality care. An integral component of care is laboratory medicine, which extends across research; screening, diagnosis, and treatment; and public health. Appropriate use of laboratory testing is essential for achieving safe, effective, and efficient care to patients.Health care must be informed by data derived from scientific assessment of efficacy and effectiveness of procedures, and must adapt to ongoing changes in science, technology, and practice. Laboratory medicine is not only responding to these changes, but is contributing to them in an environment of demographic, social, and economic change.The Centers for Disease Control and Prevention (CDC) has commissioned this report to contribute to the groundwork for transforming laboratory medicine over the next decade. CDC charged The Lewin Group, under subcontract to Battelle Memorial Institute, with drafting this document, Laboratory Medicine: A National Status Report. The report examines in detail the key factors affecting the laboratory medicine sector, and is organized into chapters on the following main topics:Value of laboratory medicine\ue2\u20ac\ua2 Market profile of the laboratory medicine sector\ue2\u20ac\ua2 Laboratory medicine workforce\ue2\u20ac\ua2 Quality and the total testing process\ue2\u20ac\ua2 Quality systems and performance measurement\ue2\u20ac\ua2 Laboratory information systems\ue2\u20ac\ua2 Federal regulatory oversight of laboratory medicine\ue2\u20ac\ua2 Reimbursement for laboratory medicinePrepared for: Division of Laboratory Systems, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention; prepared by: The Lewin Group under subcontract to Battelle Memorial Institute.Acknowledgments -- Executive summary -- Introduction -- Methods and limitations -- I. The value of laboratory medicine to health care -- II. Market profile of the laboratory medicine sector -- III. Laboratory medicine workforce -- IV. Quality and the total testing process -- V. Quality systems and performance measurement -- VI. Laboratory information systems -- VII. Federal regulatory oversight of laboratory medicine -- VIII. Reimbursement for laboratory medicine -- Appendix A. Desirable characteristics for performance measures -- Appendix B. Summary of selected performance indicators used by stakeholders -- Appendix C. Development of the Medicare payment system

Effects Of Health Information Technology Adoption On Quality Of Care And Patient Safety In Us Acute Care Hospitals

The adoption of healthcare information technology (HIT) has been advocated by various groups as critical in addressing the growing crisis in the healthcare industry. Despite the plethora of evidence on the benefits of HIT, however, the healthcare industry lags behind many other economic sectors in the adoption of information technology. A significant number of healthcare providers still keep patient information on paper. With the recent trends of reimbursement reduction and rapid technological advances, therefore, it would be critical to understand differences in structural characteristics and healthcare performance between providers that do and that do not adopt HIT. This is accomplished in this research, first by identifying organizational and contextual factors associated with the adoption of HIT in US acute care hospitals and second by examining the relationships between the adoption of HIT and two important healthcare outcomes: patient safety and quality of care. After conducting literature a review, the structure-process-outcome model and diffusion of innovations theory were used to develop a conceptual framework. Hypotheses were developed and variables were selected based on the conceptual framework. Publicly available secondary data were obtained from the American Hospital Association (AHA), the Health Information and Management Systems Society (HIMSS), and the Healthcare Cost and Utilization Project (HCUP) databases. The information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. After the data from the three sources were cleaned and merged, regression models were built to identify organizational and contextual factors that affect HIT adoption and to determine the effects of HIT adoption on patient safety and quality of care. Most prior studies on HIT were restricted in scope as they primarily focused on a limited number of technologies, single healthcare outcomes, individual healthcare institutions, limited geographic locations, and/or small market segments. This limits the generalizability of the findings and makes it difficult to draw definitive conclusions. The new contribution of the present study lies in the fact that it uses nationally representative latest available data and it incorporates a large number of technologies and two risk adjusted healthcare outcomes. Large size and urban location were found to be the most influential hospital characteristics that positively affect information technology adoption. However, the adoption of HIT was not found to significantly affect hospitals\u27 performance in terms of patient safety and quality of care measures. Perhaps a remarkable finding of this study is the better quality of care performance of hospitals in the Midwest, South, and West compared to hospitals in the Northeast despite the fact that the latter reported higher HIT adoption rates. In terms of theoretical implications, this study confirms that organizational and contextual factors (structure) affect adoption of information technology (process) which in turn affects healthcare outcomes (outcome), though not consistently, validating Avedis Donabedian\u27s structure-process-outcome model. In addition, diffusion of innovations theory links factors associated with resource abundance, access to information, and prestige with adoption of information technology. The present findings also confirm that hospitals with these attributes adopted more technologies. The methodological implication of this study is that the lack of a single common variable and uniformity of data among the data sources imply the need for standardization in data collection and preparation. In terms of policy implication, the findings in this study indicate that a significant number of hospitals are still reluctant to use clinical HIT. Thus, even though the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 was a good stimulus, a more aggressive policy intervention from the government is warranted in order to direct the healthcare industry towards a better adoption of clinical HIT

The appropriateness of clinical microbiology laboratory investigations : a retrospective study of the cost and clinical relevance of specimen management and processing

Each year, NHS clinical laboratories carry out more than 700 million laboratory tests, of which 50 million are microbiology investigations. Several studies have shown that between 25% and 40% of all tests sent to the laboratory are unnecessary, and up to 46% of ordered microbiology tests are inappropriate. In light of these accounts, the present study was undertaken to evaluate the process of microbiology specimen management in order to assess microbiology test utilisation and the appropriateness of the test ordering processes. The study focussed on respiratory tract specimens using sputum microbiology as a model for the microbiology service inappropriate test utilisation. The overall main aim of this study was to determine the appropriateness of clinical microbiology test utilisation, its clinical relevance and cost-effectiveness, hence recommend better utilisation strategies. A total of 15,941 respiratory tract samples from Barts and The London NHS Trust were randomly selected from the years 2004/05 and analysed retrospectively. Seven hundred microbiology laboratory request forms from patients for whom respiratory tract cultures were requested over a three month period were examined in detail. These requests were derived from 511 sputum specimens, 100 throat swabs, 63 ear swabs and 76 samples from other respiratory tract sites. 641 (91%) of microbiology test requisition forms were completed, provided all requested details by the service users and were therefore considered as appropriate microbiology test requisitions. 660 (94%) of those examined stated the patient’s clinical diagnosis and only in 65 (13%) of these patients was the stated diagnosis as respiratory tract infection. Sixty percent of sputum specimens examined were considered as poor quality. Forty percent of respiratory specimens were reported as culture positive, based on the local hospital criteria of microbiology test reporting. In sputum culture, 39% was reported as culture positive; however, less than 18% were positive with recognised respiratory pathogens, whilst 27% of throat swabs were reported as culture positive, of which 67% had throat pathogens. From the beginning of this study and before, there were no microbiology test comments and interpretation of test results provided with the test result reporting. The test turnaround time of respiratory microbiology results reported within three days in 2004/2005 was only 20%. The total inappropriate respiratory specimens processed locally were 9,575. Extrapolating from our results, this suggests that 2,153,977 nationally were inappropriate in NHS hospitals in 2004/2005. The total cost of inappropriate respiratory microbiology test use was approximately £152,000 in local NHS hospitals. Extrapolating from our results, this suggests that £23,900, 000 nationally was the total cost of inappropriate tests in the NHS hospitals. Following implementation of this study, follow up studies in 2006 and onwards indicated that there has been an improvement in the quality of the microbiology service. The number of good quality sputum specimens was 69% compared to 40% in 2004/2005. While the total microbiology test turnaround time that was reported within three days in 2009/2010 was more than 94%. From mid 2006 onwards, test interpretation comments have been used in all microbiology test result reporting. The total workload of respiratory tract microbiology activity decreased from 18,915/year to 16,651/year over the years 2004/2005 to 2007/2008, which is down nearly 8%. Analysis of the findings showed that the usefulness of culture results was limited by the collection of inappropriate specimens, and lack of clinical information on the microbiology request form. The crucial importance of the role of clinical and nursing staff is stressed if the clinical relevance of sputum culture is to be maximised. The increasing introduction of electronic pathology test requests gives new opportunities to restrict the collection of inappropriate specimens and make substantial savings in resources, both in the ward and the laboratory. This type of study and audit can give invaluable information about the rationale behind testing, and the appropriateness of sampling and transport time. Appropriate measures for corrective actions can be identified.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Adviser\u27s Guide to Health Care, Volume 1: An Era of Reform—The Four Pillars

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Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

Adviser\u27s guide to health care: Volume 1, An Era of Reform

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