“Though laboratory testing accounts for less than three percent of healthcare spending in the U.S., about 70 percent of all diagnostic decisions rely on lab data,” says Richard Atkin, president and CEO of Sunquest Information Systems, Inc. “Laboratory professionals play a truly vital role in diagnosis, treatment, and prognosis. We believe that continuously improving the underlying technologies and processes they use is a worthy cause.”
To that end, Sunquest sparked a great deal of conversation in 2008 when it introduced the Five Rights of Laboratory Testing. It's a concept inspired by the five rights of medication administration, which promote patient safety by encouraging clinicians to verify the patient's identification, timing and frequency, dosage, route, and drug. In addition to improving outcomes, the Five Rights of Laboratory Testing is intended to emphasize the importance of the role that diagnostic laboratories play in patient safety.
The Five Rights of Laboratory Testing states that the right test is performed on the right patient at the right time, for the right indicators, leading to the right diagnosis.
Right test: Assuring that the test being performed is the one actually requested by the physician is fundamental. To avoid errors and delays, careful attention must be given to the process of capturing order request information from the enterprise or outreach ordering systems. As with any ordering procedure, system user interfaces (UI) may vary in quality.
“People tend to underestimate the importance of a well-conceived software UI,” says Atkin. “Whether paper forms or computer screens, intuitive and intelligent processes reduce the probability of workarounds. To get that right, an ordering system should be designed with input from the clinicians who will be using it.”
Right patient: Life on the floors and in emergency rooms can be hectic. Though mistaken identity does happen - usually due to manual processes hurriedly executed under stressful conditions - it's becoming a thing of the past. From radio-frequency identification to bar-coding systems, positive patient identification solutions have proven highly effective in preventing these kinds of errors from occurring at the point of care during specimen collection and throughout the entire laboratory workflow, even circling back to transfusing blood products.
Right time: Of course, many tests are time critical. Diagnosis and treatment decisions are waiting on them. Lab workflow should be built for speed as well as accuracy, with technology ensuring both. To maintain throughput, the system must be able to issue and communicate alerts prior to collections and procedures exceeding acceptable turnaround times.
Right indicators: Delivering the right test results for the right patient at the right time - whether in the electronic medical record, physical chart, or inquiry screen - gives physicians, nurses, and physician's assistants what they need: the right indicators to guide their decision-making. Full access to prior results and confidence in data integrity will support requests for confirmatory testing or follow-up actions. Laboratory professionals can be relied upon to guide care providers in selecting appropriate tests, especially as molecular technologies and genetic evaluations are introduced in greater numbers. Pathologists and laboratory professionals are invaluable consultative resources.
Right diagnosis: The fifth right is a desired result: Patients have the information they need because their care givers have received useful, actionable information that provides clear direction for therapeutic decisions.
“The fifth right is different also in that it is something to which people should be entitled,” says Atkin. “Patients have the right to be given the right diagnosis, so they can make informed decisions about their care options and treatment plans. That's our position, and we believe that lab workflow can achieve the level of accuracy and reliability necessary to support this fundamental patient right.”
While Sunquest believes the Five Rights of Laboratory Testing will be an operating standard for the industry, it's also a guiding principle behind the development of the company's laboratory, diagnostic and point-of-care systems. “Laboratories are central to hospital operations in modern healthcare, and they will only become more so as predictive and personalized medicine emerges,” says Atkin. “We put these principles in place in part to ensure that tomorrow's diagnoses and therapies are driven by tomorrow's technology platforms.”
Sunquest Information Systems
250 South Williams Blvd., Tucson, AZ 85711, +1 (800) 748-0692, http://www.sunquestinfo.com
Healthcare Informatics 2009 September;26(9):18
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