Our "risk-mgmt" course recommends a lab test log. This is a log kept on every patient of lab tests ordered, and allows you to verify that they came in and that all tests requested were returned.

How does everyone else handle this. What I'd like to see in AC is a log kept, maybe generated from the "orders" section assuming you put lab orders there. Or some formal lab test section in the patient's chart. Then, when the labs come in electronically, a the md could pull up a list showing patient labs ordered & received. Currently, all the labs go to the doctor, which is great. But sometimes a lab doesnt get imported and AC doesnnt flag it. Or suppose a lab just doesnt come back? Both have happened to us and we have caught it, but it woujld be nice if the system had a way for this to be tracked automatically and an alert given if labs supposedly orederd were not received after some specified time--say 10 days.

I handle this by documenting in the chart that I told the patient to call for results if he/she fails to hear from us in one week after the test. I believe they have to share some of the responsibility for their care.

Leslie

I wish there was an easy answer for this but there isn't.

On very important tests. I send myself a remider to look for the result.

As far as patient's taking responsibility, it just doesn't seem to exist in the world of risk mangement. If anyone has any other ideas i'd love to know.

By the way , do you also track if a patient has kept a referral to a specialist? We have been told at our risk management seminars that if we refer to someone and the pt does not go, it is our responsibility.

Remember, if you ask for a cup of coffee and I give it to you and you spill and burn yourself, it was my fault.


Frank J. Paiano, DO

I can tell you having been the lab supervisor of my hsubands practice for many years, CLIA actually looked at this as well. For now since it is just myself and my receptionist we put a copy of the labcorp manifest on the desktop and delete it when there are all in. I am sure this is not "good enough" in the world of risk management. It would be nice with the bridge if there were a check and balance.

I guess my first question is... Who are conducting these risk management seminars? And, who is it that set the precedence that hot coffee in your crotch is my fault? I rest my case.

Leslie

Well, our malpractice insurance company did our risk mgmt seminar. That that stupid old lady and the idiotic jury decided on the coffee issue when they ruled it was McDonald's falt that she burned herself when she dropped a cup of clearly marked HOT COFFEE in her lap at the drive-thru window.

Its not automatic but, when I order a test (or consult ) it is entered into the plan section and printed off ( make a separate order for labs, another for radiology, another for referrals or consults such as colonoscopy. The orders are printed off and kept on a clip-board. Each week the staff goes thru the clipboard and checks the patients chart to see if the results have been received, discarding the printed order when complete. I know this is not paperless or automatic but it does satisfy the risk management folks for my malpractice carrier. Seems like that would not be too hard to program in to AC except that the computer would have to recognize which report is being recieved.

Florida Osteopathic Medical Association (FOMA) gives risk management lectures twice per year. The last time I attended, a member of the Florida Osteopathic Board gave the lecture. Risk Management hours are a requirement in Florida.

The hot coffee comment is from McDonald's, as Wayne noted.

Frank J. Paiano, DO

As for the McDonald's coffee incident, it bears noting that the reason she won was because the coffee was heated to a far higher degree than it should have been. According to Wikipedia (this matches what I remember and the woman did this only 4 hours from where I live) "Liebeck was taken to the hospital, where it was determined that she had suffered third-degree burns on six percent of her skin and lesser burns over sixteen percent.[11] She remained in the hospital for eight days while she underwent skin grafting. Two years of treatment followed." Link to the article http://en.wikipedia.org/wiki/Liebeck_v._McDonald%27s_Restaurants

I just don't see an easy way of handling this. If we had a full bidirectional interface with every lab, then I could I see the system automatically taking labs off the pending list when they arrive, or generating alerts when a lab is late. Everything else requires a full extra step adding the lab to an order log, and another step when someone matches an incoming lab with an entry in the log.

AC could generate an order log if you use it consistently for all your orders. It could then present outstanding orders for the particular patient when you import items to the chart. That might work without adding too much work.

This is actually a major issue, tracking orders and outstanding labs is important. I agree with Kevin,an order log that opens up when items are imported to the chart would be an excellent solution. Why wouldn't you use AC to generate all orders, referrals and labs? Done through AC the order is recorded, printed out, signed and has the diagnosis code(s). The only thing AC doesn't do is track it.

Hi Wayne
I am actually glad she won. I still cannot believe how hgh Dunkin Donuts fill their cups. I mean they KNOW you are driving. Once, I got back to the office and opened it, and it was over the top. I actually poured some off and it was still at the top. We took a picture. We called Dunkin' Donuts, and the district manager came over and was actually shocked even for them. The cups are not only clearly marked HOT, they also have a line at the top where it is supposed to go.

I don't know how often I watch other customers pull up from the drive through window, open their car door, and pour out an ounce of coffee.

This lab order thing is really puzzling me. In our clinic we have 5 providers and a diabetes prevention nurse ordering labs through AC. We are trying to remain paperless.

Does anyone ahve a 'best practice'.

Actually, has anyone in this group put together an AC manual of best practices. Maybe the group could collaborate on one?

We dont really have a good solution yet. We are currently using the "orders" form to give the the MAs to send the labs. Labs come in directly to the doctors mailbox, so she has to check to see if everything she ordered is there.

Sky,

What is your detailed method of importing documents into AC? I wrote a message last night, but it must have gone into cyberspace.