A Window to the Lab in the Emergency Department
A nurse from our Emergency Department walked into my office recently and said, “I feel we have a good working relationship with the lab, and I don’t want to write this up. I would rather just talk about it.”
OK, I supposed. She continued, “We didn’t order tests STAT on a patient we had today, and so you didn’t see the tests on your end. The lab called over and gave us a hard time about this. This nurse was a traveller who didn’t know how to order tests. I think the problem is that the system doesn’t order labs STAT for us!” QED.
“Well, I could call the vendor...” I began.
Beep-beep-beep. Back the truck up:
- Blaming technology - since inevitable human error is not our “fault,” the computer is junk. Her tunnel-visioned solution ignores the overall human process of managing order status.
- Training - should travellers receive substandard training? And is that a serious excuse?
- The lab gave the ED a “hard time” - according to the tech, when she finally discovered the orders along with other routine requests, she suggested, “You should remind this person to order all tests STAT.”
I asked techs about the ED not ordering tests STAT, which makes them flash on all terminals and print labels, presented by the nurse as a random incident. The techs all said, “That happens constantly. It drives us crazy!”
So, why not report it? The computer’s junk, the nurses don’t train their own, and techs don’t want to make ED nurses angry by “writing them up.” Fair enough.
But the ED doesn’t just “forget” to check STAT, they don’t know the status of any test without calling the lab or hearing their printer spit out a report. The solution is a dedicated terminal in the ED that displays test status. At a glance they’ll see what’s been ordered, what’s been collected, what isn’t quite done, and what is past turnaround time cutoffs. Information is power.
The lesson? Report, report, report. If we don’t know what’s really happening, we can’t have any real solutions.