A-389 Implementation of a solicited laboratory workflow improves quality indicators for point of care blood gas testing by Respiratory Therapists
Authors: Ballard E , Stieglitz H 
Published: September 2023

Abstract

Background
Quality indicators (QIs) including turnaround-time (TAT), critical result notification, corrected patient results, and unacceptable specimen are key measures of a laboratory quality management program that interrogates the pre-analytic, analytic, and post-analytic phases of the testing process. It is essential that high quality standards are maintained for critical care testing such as blood gas analysis. Achieving these high standards is difficult enough with specially trained laboratory personnel and can especially challenging with respiratory therapists (RTs) who are tasked with the difficulty of balancing patient testing while providing care. Tracking these QIs can also be cumbersome, especially if using manual methods. This retrospective study evaluates the effect of implementing a solicited laboratory information system (LIS) workflow using EPIC-Beaker on blood gas testing QIs performed at the point-of-care (POC) by RTs.

Methods
Blood gas QIs including TAT, percent of critical results notified, and number of corrected patient reports were compared between two workflows used by RTs. Metrics obtained between 1/1/2021–1/31/22 were from 13 POC blood gas analyzers from manufacturer #1, with manual TAT review of a sampling of specimens (5 days’ worth of samples per month) performed in manufacturer #1 middleware; manual review critical result notifications; and manually completed cards to track corrected reports. Metrics obtained between 2/1/22–12/31/22 were from 13 newly implemented POC blood gas analyzers from manufacturer #2, using a solicited EPIC-Beaker workflow with barcode-enabled labels for specimen tracking of collect and received times, automated review of TAT (received to result, collect to result, and collect to receive) with reports, and utilization of the communication log activity to document critical result notifications and unacceptable specimen. LIS reporting tools were used to summarize monthly TAT, critical result notification, unacceptable specimen, and corrected report QIs.

Results
Between the time periods employing the manual vs Beaker workflows, percent of results meeting the TAT were 99.5% (results within 30 minutes of receipt) vs 95.5% (results within 30 minutes of collection); percent of critical results notified was 100% vs 100%; and number of corrected reports was 132 vs 24 (demonstrating an 82% reduction), respectively. Estimated time spent reviewing/compiling QIs by RTs was ∼5 hours/week vs ∼3 hours/month with the manual vs EPIC-Beaker workflow.

Conclusion
Using an EPIC-Beaker solicited LIS workflow significantly improved the number of corrected patient reports compared to the previous workflow. Of the critical results audited each month, the percent with notification documentation remained the same between the workflows, however, using reporting tools allowed faster auditing of all critical results obtained each month compared to the manual workflow that only audited a sampling of the critical results per month due to the prohibitive time needed for manual review. TATs monitored also did not significantly change, however, the Beaker workflow allowed for simultaneous auditing of multiple measures of TAT, compared to the former workflow that only included electronic documentation of specimen ‘receipt’ by the RT and not the actual collect time. Employing automated LIS workflows may improve POC blood gas testing QIs while streamlining the process of compiling QIs.