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首页> 美国卫生研究院文献>BMJ Open Quality >Design of a state of the art reporting system and process improvement for reporting of high complexity single antigen bead data for transplant patients to the electronic medical record
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Design of a state of the art reporting system and process improvement for reporting of high complexity single antigen bead data for transplant patients to the electronic medical record

机译：最新技术报告系统的设计和流程改进用于将移植患者的高复杂性单抗原珠数据报告给电子病历

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The UCLA Immunogenetics Center is an Immunogenetics and Histocompatibility laboratory that performs testing for multiple transplant programmes within and outside of UCLA. The single antigen bead (SAB) test is a high complexity luminex bead test used to assess pretransplant and post-transplant patients for the presence of pathogenic human leucocyte antigen donor-specific antibody associated with allograft rejection. Efficient reporting of the SAB test has been difficult as data analysis and reports are generated in the laboratory information system (LIS) and uploaded to the electronic medical record (EMR) as PDFs. To solve this, we recently developed a state of the art reporting workflow allowing discrete reporting of SAB data (antibody specificity, mean fluorescent intensity and interpretative comments) from the LIS HistoTrac to UCLA Health System’s EMR EPIC:CareConnect. However, a proportion of tests did not report to the EMR appropriately. Baseline system performance data evaluated over a 10-week period showed that ~4.5/100 tests resulted in EPIC as ‘preliminary result’ or ‘in process’ instead of ‘final result’ with only common cause variation. Quality improvement methods were employed to improve the process with the SMART Aim of reporting 100% of tests as ‘final result’. Pareto analysis identified two errors accounting for 79% of common system-level failures—status errors and interface errors. We hypothesised that addressing the status error would reduce or eliminate the interface errors. We used the Model For Improvement to test a reprogramming intervention. Status and interface errors were completely resolved through the process improvement. Continuous monitoring revealed a system-level shift with only ~1.9/100 tests resulting inappropriately. Through the audit process, the remaining common system-level failures were identified and resolved. Therefore, 100% of tests result to EPIC as ‘final result’. The study demonstrates that high complexity SAB bead data can be efficiently reported EPIC:CareConnect from HistoTrac as discrete data.
机译：UCLA免疫遗传学中心是一个免疫遗传学和组织相容性实验室，对UCLA内部和外部的多种移植程序进行测试。单抗原珠（SAB）测试是一种高度复杂的luminex珠测试，用于评估移植前和移植后患者是否存在与同种异体移植排斥相关的致病性人类白细胞抗原供体特异性抗体。由于数据分析和报告是在实验室信息系统（LIS）中生成并以PDF格式上传到电子病历（EMR）的，因此很难有效报告SAB测试。为了解决这个问题，我们最近开发了一种先进的报告工作流程，可以从LIS HistoTrac到UCLA Health System的EMR EPIC：CareConnect离散报告SAB数据（抗体特异性，平均荧光强度和解释性注释）。但是，有一部分测试没有适当地报告给EMR。经过10周的评估的基准系统性能数据显示，约4.5 / 100次测试将EPIC视为“初步结果”或“进行中”，而不是仅具有常见原因差异的“最终结果”。 SMART旨在将100％的测试报告为“最终结果”，从而采用质量改进方法来改进流程。帕累托（Pareto）分析确定了两个错误，它们构成了常见系统级故障的79％，即状态错误和接口错误。我们假设解决状态错误将减少或消除接口错误。我们使用改进模型来测试重新编程干预。通过流程改进，状态和界面错误得以完全解决。持续监控显示系统级别的转变，仅导致约1.9 / 100次测试不当。通过审核过程，可以识别并解决其余的常见系统级故障。因此，100％的测试结果作为“最终结果”到达EPIC。该研究表明，可以从HistoTrac有效地将EPIC：CareConnect报告为高复杂度的SAB磁珠数据，并将其作为离散数据。

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