title: Innovative strategy for effective critical laboratory result management: end-to-end process using automation and manual call centre.
abstract: BACKGROUND
  Timely reporting and acknowledgement are crucial steps in critical laboratory results (CLR) management. The authors previously showed that an automated pathway incorporating short messaging system (SMS) texts, auto-escalation, and manual telephone back-up improved the rate and speed of physician acknowledgement compared with manual telephone calling alone. This study investigated if it also improved the rate and speed of physician intervention to CLR and whether utilising the manual back-up affected intervention rates.
  
  
  METHODS
  Data from seven audits between November 2007 and January 2011 were analysed. These audits were carried out to assess the robustness of CLR reporting process in the authors' institution. Comparisons were made in the rate and speed of acknowledgement and intervention between the audits performed before and after automation. Using the automation audits, the authors compared intervention data between communication with SMS only and when manual intervention was required.
  
  
  RESULTS
  1680 CLR were reported during the audit periods. Automation improved the rate (100% vs 84.2%; p<0.001) and speed (median 12 min vs 23 min; p<0.001) of CLR acknowledgement. It also improved the rate (93.7% vs 84.0%, p<0.001) and speed (median 21 min vs 109 min; p<0.001) of CLR intervention. From the automation audits, the use of SMS only did not improve physician intervention rates.
  
  
  CONCLUSIONS
  The automated communication pathway improved physician intervention rate and time in tandem with improved acknowledgement rate and time when compared with manual telephone calling. The use of manual intervention to augment automation did not adversely affect physician intervention rate, implying that an end-to-end pathway was more important than automation alone.
authors.affiliation: Department of Anaesthesia, Yong Loo Lin School of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore. lian_kah_ti@nuhs.edu.sg
authors.forename: Lian Kah
authors.initials: LK
authors.lastname: Ti
authors.forename: Sophia Bee Leng
authors.initials: SB
authors.lastname: Ang
authors.forename: Sharon
authors.initials: S
authors.lastname: Saw
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Sethi
authors.forename: James W L
authors.initials: JW
authors.lastname: Yip
mesh_terms: D001331:Automation / Q000295:instrumentation*; D019937:Diagnostic Techniques and Procedures; D006801:Humans; D007753:Laboratories / Q000458:organization & administration*; D013689:Telephone; D060145:Text Messaging; D013997:Time Factors