Strategies for Good Communication of the Medical Laboratory Staff with the TB Program and Healthcare Providers Vasiti Uluiviti Regional Laboratory Coordinator PIHOA 2017 PITCA Meeting Sept 11 th 15 th 2017
Overview Overview of communication errors in healthcare settings Communication in a medical laboratory Laboratory quality management systems Recommendations for strategies to enhance effective communication in the USAPI: TB Program Lab Healthcare Providers
Learning objectives At the end of this session, one shall be able to: Be reminded of the negative effects of communication errors in healthcare settings Know the importance of effective communication in a medical laboratory Know the positive impact of improved communication in a lab with an established and functional lab quality management system Know ways of improving communication between the lab and the TB program and healthcare providers
Communication Errors in Healthcare Settings Michelle O Daniel; Alan H. Rosenstein. Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Chapter 33 https://www.ncbi.nlm.nih.gov/books/nbk2637/ FAILURE TO COMMUNICATE Medical errors A pervasive problem in today s health care organizations National Center for Health Statistic s list of the top 10 causes of death in the United States medical errors would rank number 5 ahead of: Accidents Diabetes Alzheimer s disease AIDS breast cancer gunshot wounds (JCHAO, 2005)
Communication failures are the leading root cause of sentinel events 44,000 98,000 people die every year in U.S. hospitals because of medical errors. Communication failures are the leading root cause of the sentinel events reported to the Joint Commission from 1995 to 2004. Eg. medication errors, delays in treatment, wrong-site surgeries and operative and postoperative events and fatal falls (the second most frequently cited root cause) (1999 Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System) Michelle O Daniel; Alan H. Rosenstein. Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Chapter 33 https://www.ncbi.nlm.nih.gov/books/nbk2637/
Communication in a medical laboratory The product we are selling is INFORMATION 60 70% of diagnosis and treatment decisions based on lab results Essential to all aspects of health care are laboratory results that are: Accurate, Reliable, and Timely Laboratory information within a quality system produces increased knowledge and better patient care
Laboratory tests are influenced by laboratory environment knowledgeable staff competent staff reagents and equipment quality control communications process management occurrence management record keeping
Complexity of a Laboratory System Reporting Patient/Client Prep Sample Collection Personnel Competency Test Evaluations Data & Laboratory Management Safety Customer Service Sample Receipt and Accessioning Record Keeping Quality Control Testing Sample Transport 9
Path of Workflow THE PATIENT Test selection Sample Collection Preexamination Phase Sample Transport Laboratory Analysis Examination Phase Report Transport Report Creation Result Interpretation Postexamination Phase 10
WHY is the Path of Workflow essential to consider in health laboratories? The entire process of managing a sample must be considered: the beginning: sample collection the end: reporting and saving of results all processes in between.
Laboratory errors cost in time personnel effort patient outcomes Errors can occur within the total testing process Preanalytic, analytic, and postanalytic phases of testing
In the post-analytic phase, good communication between clinicians and medical laboratory professionals is necessary to ensure quality of care. Lack of formal training of clinicians or laboratory professionals in effective communication (The Lewin Group. Laboratory medicine: a national status report. Update 2008-2009: patient centered care and laboratory medicine. May 2009) Wide variability in the criteria and method for rejecting sample results due to suspected errors occurring in the preanalytic phase of testing and no standardized policies (Simundic AM, Lippi G. Pre-analytical phase--a continuous challenge for laboratory professionals. Biochem Med (Zagreb) 2012;22:145 9)
Four possible scenarios may occur every time a patient sample is analyzed and evaluated by the laboratory scientist: (1) contamination present but unrecognized (false-negative) (2) contamination present and identified (true-positive) (3) no contamination present but suspected (false-positive), and (4) no contamination present and recognized as a quality sample (true negative). Note: The first and third scenarios can result in error and potential patient harm.
LABORATORY So, what do we do? Deliver the lab test result that is Accurate, Reliable, and Timely AT ALL TIMES!!!
Quality System Essential (QSE) -Process Improvement- LQMS Assessment of USAPI Laboratories: 2010 2013 ALL LABS SCORED 0% FOR PROCESS IMPROVEMENT
How do we do that? Awareness Communicate Investigate The Occurrence Cycle ACTION
Twelve Quality System Essentials Organization Personnel Equipment set of coordinated activities that function as building blocks for quality management Purchasing & Inventory Process Control Information Management Documents & Records Occurrence Management Assessment Process Improvement Customer Service Facilities & Safety
Twelve Quality System Essentials set of coordinated activities that function as building blocks for quality management Organization Personnel Equipment Purchasing & Inventory Process Control Information Management Path of Workflow Documents & Records Occurrence Management Assessment Process Improvement Customer Service Facilities & Safety
Occurrence Management Learn from the event and avoid its recurrence Preventive actions See the potential event and plan to avoid it EVENT Remedial actions Corrective actions Address the event and its consequences
Implementing Quality Management does not guarantee an ERROR-FREE Laboratory But it detects errors that may occur and prevents them from recurring 21
Organizatio n Personnel Equipment Purchasing & Inventory Process Control Information Management Laboratories not implementing a quality management Documents & Records Occurrence Manageme nt Assessmen t system guarantees UNDETECTED ERRORS Process Improvement Customer Service Facilities & Safety 22
Strategies to enhance effective communication in the USAPI: TB Program Lab Healthcare Providers Recommendations Short term (next 3 months) 1. Consistent routine meetings in the lab. 2. Consistent routine meetings with the lab (TB Program & Healthcare provider) Frequency: Monthly Topics: Lab supplies, Quarterly reports, Occurrences and its management, etc. 3. Ensure well documented policies and procedures 4. Training of new hires and re-fresher training Long term (next 6 months) 5. Evaluate the TB program communication strategy and identify barriers to effective communication in each juriadiction 6. Development of a structured USAPI TB Program Communication Toolkit
5. Development of a USAPI TB Program Communication Toolkit Study: 477-bed medical center of the Denver Health and Hospital Authority (an integrated, urban safety-net system) Purpose: to develop, implement, and evaluate a comprehensive provider/team communication strategy, resulting in a toolkit generalizable to other settings of care. Methods: pre-test/post-test design, baseline and post-intervention data were collected on pilot units (medical intensive care unit, acute care unit, and inpatient behavioral health units). Results: Analysis of 495 communication events after toolkit implementation revealed: 1. Decreased time to treatment 2. Increased nurse satisfaction with communication 3. Higher rates of resolution of patient issues post-intervention Dingley, C., Daugherty, K., Derieg, M. K., and Persing, R. Improving Patient Safety Through Provider Communication Strategy Enhancements (Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools) by Henriksen K, Battles JB, Keyes MA, et al., editors. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug). https://www.ncbi.nlm.nih.gov/books/nbk43663/
5. Development of a USAPI TB Program Communication Toolkit Main objectives: Provides an overview of the structured communication process across the disciplines Provides the various disciplines with the means to implement teamwork and communication strategies in their own settings 5 components: 1. Patient 2. Nurse 3. TB Physician 4. TB Program Manager/Coordinator 5. Laboratory technologist/technician[similar to job aid that does not replace a standardized operating procedure (SOP)] Laminated and disseminated to each station
References: Michelle O Daniel; Alan H. Rosenstein. Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Chapter 33. https://www.ncbi.nlm.nih.gov/books/nbk2637/ Dingley, C., Daugherty, K., Derieg, M. K., and Persing, R. Improving Patient Safety Through Provider Communication Strategy Enhancements (Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools) by Henriksen K, Battles JB, Keyes MA, et al., editors. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug). https://www.ncbi.nlm.nih.gov/books/nbk43663/ Katz, C., McNicholas, K., Bounds, R., Figurelle, T., Jones, C., Farley, H., Witkin, G., McLane, M. A., and Steven R. Johnson, S. R. (2013). Improving Patient Safety Through Enhanced Communication Between Emergency Department Clinicians and Medical Laboratory Staff. Journal of Clinical Outcomes Management, 20 (10), 455-462. Passiment E, Linscott A. 2014. Effective Communication in Laboratory Management, p 451-457. In Garcia L (ed), Clinical Laboratory Management, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817282.ch23
Thank you! vasitiu@pihoa.org 27