Lean Laboratory Order Management System

Operating the laboratory

Order processing helps the laboratory run smoothly. Laboratory order processing systems encompass every aspect of the laboratory testing process. Each stage—from initial order by a nurse, practitioner or physician through sample collection, testing and results reporting—is included. 

Accurate order inventory management and tracking help the laboratory consistently deliver on its TAT and patient care commitments.

Shaping patient experience

A patient’s experience with the health system is influenced by patient flow: his or her physical movement through a facility’s departments. Patient flow includes every touch point from admissions to discharge. People, processes and systems—including laboratory order processing systems—directly impact patient flow.

Lack of optimization in patient flow can cause extended wait times, which can negatively impact a patient’s experience.

Safeguarding patient safety

According to the United States Centers for Disease Control and Prevention, “Lab test errors are among the most frequent in primary care and are also among the most likely to cascade to patient harm when they occur.”¹ Management and communication of test results—through the laboratory order processing system—is a factor in delivering high-quality patient care.

Asante Ashland Community Hospital (Asante) is a 49-bed community hospital that features a birthing center and a surgery center, in addition to diagnostic imaging, laboratory and respiratory testing services. Outpatient services include internal medicine, home health and hospice care, wound care, and hyperbaric medicine.

Laboratory testing is an important component within Asante’s healthcare services. However, their laboratory ordering process was based on manual order transports and a registration file cart, as well as faxed orders and a faxed order-log spreadsheet at reception. There was no ability to place an online laboratory order.

The system in place was causing several customer service issues for Asante. Patients were experiencing long waits to receive results and health care. Also, laboratory orders were frequently misfiled. This misfiling delayed order fulfillment—further elongating wait times—and posed a potential risk of preventable errors. (See Figure 1.)

Issues with the Order Management System

 Figure 1. The laboratory experienced a high amount of lost, misfiled and missing orders prior to their new order processing system.

Issues with the laboratory order processing system were impacting patients and providers. The hospital needed to make changes.

Collaboration and solutions

Asante collaborated with the Beckman Coulter performance partnership team to achieve several specific goals:

• Shorten laboratory-related wait times after patients arrive
• Reduce lead time for orders to be filed
• Lower the number of lost or duplicate orders

To address the issues, the laboratory used a problem-solving process that began with identifying the cause of the problem, which could then guide a sustainable countermeasure. (See Figure 2.)

Figure 2. This sequence of problem-solving steps helped Asante transform their order management system. 

As a result of the problem-solving process, the team focused on two overarching activities:

• Eliminating manual order transports, the registration file cart and the fax order-log spreadsheet
• Becoming a HIPPA-compliant system

Digitizing the manual process

Asante’s new process entailed that all fax-received laboratory orders would be scanned into a centralized digital location. Both the laboratory and registration staff would be able to access the location.

This new digital process eliminated manual filing, which sometimes resulted in misfiling and risk for medical error. Making the scanned order images searchable by patient name and date of birth also made viewing multiple orders for a single patient easier.

Creating standard work

For the new digital process to be successful, all staff would need to complete the same tasks the same way.

The solution was to expand the use of Meditech software features, a laboratory software package already implemented at Asante. In the clinical outpatient scheduling module, the laboratory created a scheduled clinical account for each patient with an order on file. Staff would then scan orders for each patient into the appropriate corresponding scheduled accounts.

From an organizational process change perspective, the laboratory needed to install Meditech scanners throughout the hospital’s departments. Phlebotomy and clerical staff were granted access to the tool. Standard work details were developed along with  policies and procedures for phlebotomy, registration and laboratory clerical staff to follow for improved consistency.

When it was time for deployment, the team generated core competency checklists for all affected staff members to follow. This gave the team actionable and reportable insights on organizational readiness.

Following Lean-based methods to identify root cause and implement the appropriate countermeasures set the laboratory up for sustainable success.

The new Lean order processing system improved performance in several key metrics. (See Figure 3.)

• Decreased order wait time from 200 to 80 minutes, enabling faster access to data for patient care decision making
• Reduced patient wait time by 25%, supporting a better patient experience
• Lowered the volume of patients experiencing extended wait times by 77%, demonstrating the optimization of patient flow

Performance Improvements Resulting from Lean Order Processing System

Figure 3. The Lean order processing system delivered benefits that elevated laboratory operations and advanced patient care.

What role could Lean order processing play in improving patient safety in your hospital? Could streamlining order processing and improving patient flow reduce wait times? Let our performance partnership consultants create a program of continuous improvement targeted to the needs of your healthcare system. Contact us for more information.

If you'd like to learn more ways to improve laboratory processes, check out additional Beckman Coulter case studies, posters or videos to find out what our customers have to say.