BUILDING BLOCKS STATE CASE STUDY #5: Streamlining the Accessioning Workflow for Specimens Associated with Electronic Orders

Wisconsin Newborn Screening Program

BACKGROUND

When newborn screening specimens are received in the laboratory, they need to be processed in a timely manner. In the Wisconsin Newborn Screening Laboratory, specimens associated with electronic test orders and results (ETOR) are accessioned individually. Given the increased time to accession individually (compared to the batch accessioning process for non-ETOR specimens), it is essential that the accessioning workflow for ETOR specimens be as streamlined (and error-free) as possible to avoid any additional delays.

PROBLEM

Errors with electronic orders, including missing orders, can potentially delay specimen processing, as can any difficulties laboratory staff experience finding the appropriate electronic orders for received specimens.

SOLUTION

Electronic orders are reviewed by the Wisconsin NBS lab the day they are placed, allowing for any errors to be resolved by the time the specimens are received. We require that ETOR partners include the newborn screen card number (barcoded) with the electronic order. The card number is copied to order segment PID.18 (visit number) where it functions as an alternative requisition identifier (providing receiving staff with a ‘link’ to the electronic order). The card number is preferred over the hospital-assigned specimen number as a ‘link’ to the electronic order because it is unique. Multiple ETOR partners may use the same specimen numbering format (example: [year]-[day of year]-[collection of day]) and thus it is possible that multiple electronic orders from different submitters may share the same (external) specimen number. Specimens submitted from the ETOR partners are segregated as they are received, and receiving staff immediately confirm a requisition exists for every card using the barcoded card number. This check identifies any specimens received without an electronic order and allows time to obtain the missing order before accessioning. For ease of data entry flow, specimens are accessioned in blocks with those associated with ETOR (i.e. those requiring limited data entry) accessioned last, after all other non-ETOR specimens (i.e. those requiring full data entry) have been received into the laboratory information system.