Detailed specimen tracking should exist inside every laboratory. The one unforgivable transgression for a laboratory is to lose or mismatch a patient specimen.
Every specimen IS a patient. There is simply too much risk and potential for catastrophic patient loss without having an effective specimen tracking solution installed in every laboratory.
It is impossible to have a comprehensive quality system in place without having a specimen tracking solution.
All effective specimen tracking solutions should have four areas of focus:
Simply stated, positive patient identification is the process of ensuring that a patient specimen submitted to a laboratory ends up with a result going back for the submitted specimen to the correct patient.
This is often the initial goal of many attempts to introduce specimen tracking processes. There are huge legal ramifications to providing the wrong results to the wrong patient and this is many times the sole focus of a specimen tracking initiative.
The importance of positive patient identification to an effective quality system should be obvious.
Ensuring that a specimen is correctly matched with the patient that submitted the specimen is of critical importance to all laboratories.
It is also critical to ensure that the exact specimen for that patient remains tracked in an instance where multiple specimens were submitted.
Chain of custody is the process of understanding where a specimen (or components of a specimen) are at all times when they are in a laboratory. A comprehensive system will allow laboratory personnel to know everyone that came in contact with a specimen and the exact second that the specimen passed through a data collection point.
The system should allow for checks and balances to ensure that if a specimen does not make it from one point in the workflow to the next that this can be identified in a timely manner. In other words, the system should eliminate the possibility for lost specimens.
If mistakes are made in processing the specimen, the system should allow for the identification of who worked with the specimen at each point so that corrective action can be taken to eliminate the opportunity for future errors.
Chain of custody should also include information to allow for disclosure of what equipment was used in the processing of the specimen. If a tainted batch of chemicals or issues with a piece of equipment are discovered, it should be possible to determine all specimens that passed through the defective or malfunctioning equipment during the time that the performance variance existed.
From the perspective of a comprehensive quality system, it is mandatory to be able to determine where a specimen is at all times, who has touched the specimen, and what equipment was involved in the creation of the finished work product.
Productivity measurement is used to determine all of the metrics associated with how much work was produced by employees and equipment in the laboratory. At first glance, this component of a specimen tracking system may seem more of a side benefit rather than a mandatory set of features. However, that is not the case. While patient safety is without question the most important goal of a specimen tracking solution, measurement of productivity cannot be ignored. With shrinking reimbursement rates, laboratory management needs detailed data collection information to be able to effectively manage the profitability of a facility and the workforce.
Productivity management allows laboratory management to determine how much work is being performed and by whom. If employees prepare too many specimens in a given period of time, it could indicate that they are not focused on specimen quality. It could indicate overworking conditions which could lead to an increased opportunity for mistakes. Lower productivity could indicate poorly trained employees, which introduce an entirely different set of risks. A well designed system will assist laboratory management in effectively managing the resources at their disposal.
Productivity management also allows for the monitoring of the machinery in the laboratory. Equipment that is over utilized without chemical changes can introduce specimen processing to risk. Equipment that is underutilized can have issues with chemical expiration or lack of effectiveness. Equipment that is not properly maintained can be expensive to fix or clean. A comprehensive specimen tracking system allows for management of the non-human resources in the facility as well.
From a quality system perspective, the ability to monitor the performance of employees and equipment is crucial. Without the ability to effectively manage the resources of the lab, intelligent decisions cannot be made when isolating problems and taking corrective action. Intelligent decisions regarding the correct investment in human resources and fixed assets are much more difficult without the metrics with which to monitor performance.
Media consumption and creation is the process of communicating information effectively regarding a specimen. Many labs do not have the basic communications infrastructure in place that many office environments take for granted. Due to the nature of laboratories and equipment, access to the basics such as email are sometimes complicated. The inability to effectively communicate with technicians can introduce complications in the effective operation of the laboratory.
A comprehensive specimen tracking solution will provide the ability to more effectively communicate with technicians. Messages should be capable of being tied to a specimen. Technicians should encounter these messages as the specimen is being processed. Management notifications should be able to be communicated to a technician by management without having to be on the laboratory floor.
Other examples would involve the capture and display of quality control notes during the processing of specimens across the various data collection points. Keeping track of how many pieces of specimen exist to ensure that all components of the specimen were processed correctly. Messaging notes to convey additional special instructions to technicians should be displayed as the cases are scanned in the laboratory. Imaging capability should be present, both to view and capture unusual situations. Tracking of things such as which waste bin a specimen container was placed creates information that is invaluable to laboratory technicians.
Additional examples of media consumption would be the display of electronic worktickets, prescription sheets, and training materials. These can be tied to specimen types or can be assigned to individual technicians. Electronic scoreboards should be present to alert to the upcoming end of processor or slide staining runs.
From a quality system perspective, the ability to provide detailed information to technicians as they work on cases is a critical component of a specimen tracking system. Improved communications makes technicians more informed. A more informed technician produces better specimens.