Wisconsin Diagnostic Laboratories, Wisconsin, United States
Background/Case Studies: In May 2024 data for duplicate type and screen (TS) orders at a 766 bed level one trauma center was analyzed due to staff complaints about the volume of duplicate orders. Current practice was to call the patient care provider to verify if repeat testing was desired. Data showed that in April and May 2024 blood bank (BB) received approximately 185 duplicate TS orders per month. This is roughly 5% of all TS orders and 6 daily phone calls, totaling 30 minutes, to patient care teams regarding duplicate orders.
Study
Design/Methods: In August 2024, duplicate order pop-up warnings were implemented in the EMR for TS orders placed within 72 hours of a resulted TS. By September 2024 the number of duplicate TS orders dropped to 62. In September 2024, the BB started reporting the duplicate TS orders via the hospital patient safety event reporting system. The common response from the patient care team was that the duplicate pop-up warning was not received at order. In October 2024, the claim of failed warnings was investigated. In December 2024, IT implemented a duplicate procedure report in the EMR to use as a tool to determine if the warnings fired and the user’s response (bypass and continue the order or cancel the duplicate order). It was determined that in 70% of situations, the warning did fire and in over half of those cases it was bypassed. BB worked with the patient care area with the most duplicate orders. Education was provided about the pop-up warnings and the situations in which they may not fire. In January 2025 BB explored a hard stop to auto cancel orders placed within 60 hours of a resulted TS. Due to limitations of the EMR, this was not put into effect. In January 2025 the patient safety events started including the name of the provider that bypassed the duplicate warning. The events were monitored for trends in patient care area and ordering provider. In March one provider accounted for nearly 20% of duplicate TS orders. This provider was counseled by the BB medical director. The number of duplicate TS orders averaged 31 per month since January 2025 down from 185 in April 2024.
Results/Findings: Over the course of a year duplicate TS orders decreased by 88%. They now account for less than 1% of all TS orders.
Conclusions: Process improvement projects can have great success with continued persistence and adjustments to the processes. Each step along the way can lead to further improvements. These improvements benefit patients by decreasing unnecessary blood draws. The improvements benefit the laboratory by decreasing time spent making phone calls and running unnecessary tests and money spent on reagents and supplies for testing. The projected annual cost savings of this project is $18,000 in testing supplies and technologist time for the unnecessary testing, 11L patient blood drawn, and 180 hours of time spent on the phone.
