title: Failure to review STAT clinical laboratory requests and its economical impact.
abstract: BACKGROUND
  Failure to follow-up laboratory test results has been described as one of the major processes contributing to unsafe patient care. Currently, most of the laboratories do not know with certainty not only their rate of missed (or unreviewed) requests but the economical cost and impact that this issue implies. The aim of our study was to measure that rate and calculate the resulting costs.
  
  
  METHODS
  In January 2015, we checked in our Laboratory Information Management System (LIMS) for every emergency request from 1(st) July 2011 to 30(th) June 2014, if they had been reviewed by any allowed user or not. 319,064 requests were ordered during that period of time. Results were expressed as "ordered requests", "missed requests" and its percentage. Additionally, total cost of missed requests was calculated in euros (€). "Non-productive days" were theorised (as the days producing requests that were not reviewed) based on these results.
  
  
  RESULTS
  7924 requests (2.5%) were never reviewed by clinicians. This represented a total cost of 203,039 € and 27 "non-productive" days in three years. Significant differences between inpatients, outpatients and emergency department as well as different emergencies units were found after application of statistical analysis.
  
  
  CONCLUSIONS
  In terms of resources, never reviewed or missed requests appear to be a not negligible problem for the clinical laboratory management. Electronic result delivery, with electronic endorsement to indicate follow-up of requests along with better systems of electronic requesting should be investigated as a way of improving patient outcomes and save unnecessary expenses.
authors.affiliation: Laboratory of Biochemistry, Hospital Clínico Universitario Valencia, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodriguez-Borja
authors.affiliation: Laboratory of Biochemistry, Hospital Clínico Universitario Valencia, Valencia, Spain.
authors.forename: Celia
authors.initials: C
authors.lastname: Villalba-Martinez
authors.affiliation: Laboratory of Biochemistry, Hospital Clínico Universitario Valencia, Valencia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Barba-Serrano
authors.affiliation: Laboratory of Biochemistry, Hospital Clínico Universitario Valencia, Valencia, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Carratala-Calvo
mesh_terms: D019963:Clinical Chemistry Tests / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D002984:Clinical Laboratory Information Systems / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D004526:Efficiency; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006403:Hematologic Tests / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: clinical laboratory information systems; extra-analytical phase; health care; quality indicators; total quality management