Computerised Pathology Test Order-Entry Reduces Laboratory Turnaround Times And Influences Tests Ordered By Hospital Clinicians: A Controlled Before And After Study

¹ University of New South Wales, Australia
² Royal Prince Alfred Hospital, Australia

^* To whom correspondence should be addressed. E-mail: j.westbrook{at}unsw.edu.au.

Accepted 27 June 2005

	Abstract

Aim: To assess the impact of a computerised pathology order-entry system on laboratory turnaround times and test ordering within a teaching hospital.

Methods: A controlled before and after study compared test assays ordered from 11 wards two months before (n=97,851) and after (n=113,762) the implementation of a computerised pathology order-entry system (Cerner Millennium Powerchart). Comparisons of: laboratory turnaround times; frequency of tests ordered and specimens taken; proportions of patients having tests; average number per patient; and percentage of gentamycin and vancomycin specimens labeled as random were made.

Results: Intervention wards experienced an average decrease in turnaround of 15.5 minutes/test assay (73.8 to 58.3 minutes, p<0.001). Reductions were significant for prioritised and non-prioritised tests, and for those performed within and outside business hours. There was no significant change in the average number of tests (p=0.228), nor specimens per patient (p=0.324), and no change in turnaround time for the control ward (p=0. 218). Use of structured order screens enhanced data provided to laboratories. Removing three test assays from the liver function order-set resulted in significantly fewer of these tests.

Conclusions: Computerised order-entry systems are an important element in achieving faster test results. These systems can influence test-ordering patterns through structured order screens, manipulation of order-sets and analysis of real-time data to assess the impact of such changes, not possible with paper-based systems. The extent to which improvements translate into improved patient outcomes remains to be determined. A potentially limiting factor is clinicians' capacity to respond to, and make use of, faster test results.

Key Words: Clinical laboratory information systems, Evaluation, Outcome assessment

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