title: Significant reduction of laboratory specimen labeling errors by implementation of an electronic ordering system paired with a bar-code specimen labeling process.
abstract: OBJECTIVE
  We measure the rate of emergency department (ED) specimen processing error reduction after implementation of an electronic physician order entry system paired with a bar-coded specimen labeling process.
  
  
  METHODS
  A cohort pre- and postintervention study was conducted in the ED during a 61-month period ending September 2008 in a large urban teaching hospital. Historically, laboratory order and requisition processing was done by hand. Interventions included implementing an ED-specific electronic documentation and information system, which included physician order entry with patient verification through bar-coded wristbands and bar-coded specimen labels. The main outcome measure was processing error rate, defined as unlabeled/mislabeled/wrong patient specimen or requisition. Pre- and postimplementation data were tabulated monthly and compared in aggregate by χ(2) test. The contribution of ED error to total institution specimen error was also calculated.
  
  
  RESULTS
  Of the 724,465 specimens collected preintervention, 3,007 (0.42%) were recorded as errors versus 379 errors (0.11%) of 334,039 specimens collected postintervention, which represents a 74% relative and 0.31% absolute decrease (95% confidence interval 0.28% to 0.32%). The proportion of institutional errors contributed by the ED was reduced from 20.4% to 11.4%, a 44% relative and 9.0% absolute reduction (95% confidence interval 7.7% to 10.3%). Subanalysis revealed that the majority of continued errors occur when the physician order entry/bar-code system could not be used (eg, blood bank or surgical pathology specimens).
  
  
  CONCLUSIONS
  Combining an electronic physician order entry with bar-coded patient verification and electronic documentation and information system-generated specimen labels can significantly reduce ED specimen-related errors, with sizable influence on institutional specimen-related errors. Continued use of hand labeling and processing for special specimens appears inadvisable, though the cost-effectiveness of this intervention has not been established.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. phill@jhmi.edu
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hill
authors.forename: Darren
authors.initials: D
authors.lastname: Mareiniss
authors.forename: Paula
authors.initials: P
authors.lastname: Murphy
authors.forename: Heather
authors.initials: H
authors.lastname: Gardner
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Frederick
authors.initials: F
authors.lastname: Levy
authors.forename: Gabor D
authors.initials: GD
authors.lastname: Kelen
mesh_terms: D001800:Blood Specimen Collection / Q000379:methods / Q000592:standards; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D001330:Electronic Data Processing / Q000458:organization & administration / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D050316:Medical Order Entry Systems / Q000458:organization & administration / Q000592:standards; D013048:Specimen Handling / Q000379:methods* / Q000592:standards