Purpose: The purpose of this quality improvement project was to improve the accuracy with which specialty-dependent lab orders entered by providers into Computerized Patient Record System (CPRS) at the Salisbury VA Medical Center are translated into the correct send-out lab diagnostic test codes. When a provider ordered a specialty test in CPRS, it was not always translated into the correct test code for our reference laboratory. The example studied was when the provider entered the CPRS order for kappa/lambda light chain ratio, the kappa/lambda light chain total ratio test code was selected by the lab technician instead of the kappa/ lambda light chain free ratio test code, which was the intended order. Such mistranslations can result in delays in diagnosis and treatment, are inefficient, and may result in extra blood being drawn and extra charges to the VA once the correct lab is processed.
Results: Using the above example, we determined that 102 kappa/lambda light chain ratio orders were mistranslated into kappa/lambda light chain total ratio test codes between October 1, 2014, and December 31, 2014. Once this mistranslation was recognized, the correct test code for kappa/lambda light chain free ratio was linked to the order in mid-December 2014. Our goal was to reduce the number of mistranslated kappa/lambda light chain ratio orders by 90% by June 30, 2015. From January to March 2015, the number of mistranslated orders was reduced by 20% and from April to June 2015, the number was reduced by 89%.
Conclusions: The benefits of this project include improved efficiency on the part of the lab and provider, increased veteran quality of care and satisfaction, decreased overall lab cost, and decreased time to diagnosis and initiation of treatment.
