Cracking the Case of the Missing Lab Orders

Patients and specimen samples showing up without orders was a common occurrence at the East Denver Medical Office lab.

In some cases, orders weren’t in the system because there was confusion between the provider and the nurse about who ordered the test. Other times, patients were directed to the lab without verification of a lab order; and orders simply expired.

This lack of follow-through was inconvenient for the patient, who would have to go back to his or her doctor, or wait for a lab employee to contact the department. In some cases, the patient would have to make a second trip.

So, the East Denver team decided to crack down and got a little creative.

They developed an “enforcement” theme and dressed up in police uniforms to issue citations to “violators” as they tracked patients with no orders.

Departments with the most improvement were honored with coffee and donuts. Those that met the criteria for sustained success were recognized with lunch.

OB/GYN went from 42 “violations” in a seven-week period to 34 in a 10-week period. Pediatrics went from 16 occurrences to a single one in similar time frames.

“At first, we didn’t give them (other departments) the specific data,” lab clinical manager Lucy Tyler says. “Then OB asked for it so we started giving it to everyone.”

The team found by tracking the data, they discovered who needed help, and they worked with that team to solve the problem. By showing each department when they were sending patients and specimens to the lab without orders, they could see they were part of the problem.

In some cases it was a surprise.

“This work supports X-ray and pharmacy, too,” phlebotomist Alma Lahti says. “It’s improving orders in other departments.”