Significant Reduction of Laboratory Specimen Labeling Errors by Implementation of an Electronic Ordering System Paired With a Bar-Code Specimen Labeling Process

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• 作者：Peter M. Hill ; Darren Mareiniss ; Paula Murphy ; Heather Gardner ; Yu-Hsiang Hsieh ; Frederick Levy ; Gabor D. Kelen
• 刊名：Annals of Emergency Medicine
• 出版年：2010
• 出版时间：December 2010
• 年：2010
• 卷：56
• 期：6
• 页码：630-636
• 全文大小：365 K

文摘

Study objective

We measure the rate of emergency department (ED) specimen processing error reduction after implementation of an electronic physician order entry system paired with a bar-coded specimen labeling process.

Methods

A cohort pre- and postintervention study was conducted in the ED during a 61-month period ending September 2008 in a large urban teaching hospital. Historically, laboratory order and requisition processing was done by hand. Interventions included implementing an ED-specific electronic documentation and information system, which included physician order entry with patient verification through bar-coded wristbands and bar-coded specimen labels. The main outcome measure was processing error rate, defined as unlabeled/mislabeled/wrong patient specimen or requisition. Pre- and postimplementation data were tabulated monthly and compared in aggregate by χ² test. The contribution of ED error to total institution specimen error was also calculated.

Results

Of the 724,465 specimens collected preintervention, 3,007 (0.42 % ) were recorded as errors versus 379 errors (0.11 % ) of 334,039 specimens collected postintervention, which represents a 74 % relative and 0.31 % absolute decrease (95 % confidence interval 0.28 % to 0.32 % ). The proportion of institutional errors contributed by the ED was reduced from 20.4 % to 11.4 % , a 44 % relative and 9.0 % absolute reduction (95 % confidence interval 7.7 % to 10.3 % ). Subanalysis revealed that the majority of continued errors occur when the physician order entry/bar-code system could not be used (eg, blood bank or surgical pathology specimens).

Conclusion

Combining an electronic physician order entry with bar-coded patient verification and electronic documentation and information system–generated specimen labels can significantly reduce ED specimen-related errors, with sizable influence on institutional specimen-related errors. Continued use of hand labeling and processing for special specimens appears inadvisable, though the cost-effectiveness of this intervention has not been established.