Implementation of Important Results Reminder (IRR) by Clinical Inbox

Abstract Description

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Authors (including presenting author) :

Yuen SK (1), Chan Jenny (1), Cheung WM (1)

Affiliation :

(1) Quality & Safety Unit, Caritas Medical Centre

Introduction :

Laboratory investigations play important roles in modern medical practice. Multiple steps are involved from the order of the test to the clinical management based on the test results. These are prone to human and technical errors. There is no fool-proof way to make sure serious or abnormal results are attended timely and appropriately. Hospital Authority (HA) set up a taskforce and designed the Important Results Reminder (IRR) using clinical inbox for abnormal histo-cyto-pathology reports that involve malignancy (identified by SNOMED code). This is a ‘safety net’ system and is not a replacement of existing laboratory reporting system of any hospital. A ‘reminder’ of the abnormal report (cases with malignancy) is pushed to department folders and expected to be ‘mark read’ by 14 days. Individual hospitals need to define their own ‘mark read’ policy to ensure system effectiveness. An implementation workgroup was set up in Caritas Medical Centre (CMC) for this purpose.

Objectives :

Patients with pathologically suspected or confirmed malignancy (as defined by SNOMED codes) are reviewed by more experienced doctors of each department. It reduces the chance of overlooking abnormal results but and also provides a chance for senior staff to review if timely and appropriate management has been provided.

Methodology :

While all doctors got access right to ‘mark read’ reports accumulated in their respective department clinical inbox, each department appointed subject officer(s) to ensure compliance and timeliness. Department representatives in the workgroup also feedback on users’ experience and suggest areas for improvement. After system upgrade in early 2018, cytopathology requests made by GCRS or manual forms were covered by the system. Reports positive for malignancy bypassed the IRR if the initial requests were made manually with non-CORP ID (rather than through GCRS) at LIS registration. In 2-3Q 2018, new chops incorporating CORP ID were dispensed to doctors so as to facilitate their provision of the correct CORP-ID for registration. Effective from 1 September 2018, while hand-written forms were still accepted, all cytopathology request using manual forms should include a valid CORP ID. To deal with non-compliance and yet avoid delay in specimen processing, colleagues at the laboratory registration counter might enter CORP ID of the COS (or delegate) if they had exhausted methods to identify the correct requesting doctor timely. This ensured all cytopathology requests were covered by the IRR system.

Result & Outcome :

From 27 December 2017 to 8 October 2018, a total of 226 messages had appeared as IRR in clinical inboxes of various departments. The ‘mark read’ rate within 14 days was mostly 100%.