The introduction of computerized provider order entry (CPOE) systems is associated with major changes in work processes. Implementation strategies need to consider how the technology will affect and be affected by the organization in which it is being installed. The aim of this study was to examine the potential effect of the introduction of a CPOE system on key work processes in a hospital blood bank by using qualitative data from focus groups, interviews, and participant observation and quantitative data of telephone communication. We found that work practices in the blood bank are made up of a mosaic of collaborative processes underpinned by communication channels to facilitate safe and efficient work practices. The introduction of CPOE systems requires consideration of these channels and of the ways that CPOE may disrupt existing communication processes. There needs to be high levels of staff preparedness to minimize patient risk and optimize performance.
Safety and Efﬁciency Considerations for the Introduction of Electronic Ordering in a Blood Bank Andrew Georgiou, MSc; Tony Greenﬁeld, MHA; Joanne Callen, PhD; Johanna I. Westbrook, PhD ● The introduction of computerized provider order entry The implementation of computerized provider order en- (CPOE) systems is associated with major changes in work try (CPOE) systems provides a possible foundation for en- processes. Implementation strategies need to consider how hancing the role of pathology services in the patient care the technology will affect and be affected by the organi- process.4 These systems enable doctors, and other autho- zation in which it is being installed. The aim of this study rized clinicians to issue orders electronically, leading to was to examine the potential effect of the introduction of efﬁcient order communication and decision support at the a CPOE system on key work processes in a hospital blood point of ordering. However, CPOE introduction can also bank by using qualitative data from focus groups, inter- be associated with important and disruptive changes to views, and participant observation and quantitative data of laboratory and clinical professionals’ work practices and telephone communication. We found that work practices processes.5 The planning and implementation of these sys- in the blood bank are made up of a mosaic of collaborative tems requires consideration of how the technology will processes underpinned by communication channels to fa- both affect and be affected by the organization in which cilitate safe and efﬁcient work practices. The introduction it is being installed.6 This is of particular importance for of CPOE systems requires consideration of these channels pathology departments, which consist of a diverse range and of the ways that CPOE may disrupt existing commu- of services, each with its own unique tasks and require- nication processes. There needs to be high levels of staff ments.2 preparedness to minimize patient risk and optimize per- Pathology services have received limited attention in the formance. research literature on CPOE,7 with even less consideration (Arch Pathol Lab Med. 2009;133:933–937) of speciﬁc pathology departments and their particular or- ganizational and technical features. The blood bank was chosen for study because of the critical role it has in the P athology services have been described as the ‘‘hidden science that saves lives.’’ 1 They make an essential con- tribution to the effective prevention, detection, and man- safety and quality of patient care. Our aim was to describe key work processes of laboratory professionals within a hospital blood bank and examine the potential effect of agement of disease but are still widely perceived as a the introduction of CPOE systems by using qualitative backroom function,2 with many people unaware of their data from focus groups, interviews, and participant ob- vital, ongoing importance.1 There are many signs that this servation and quantitative data of telephone communica- situation is changing, particularly with the emphasis on tion. the role of pathology in patient pathways beginning with the selection of the most appropriate test or investigation METHODS onto the interpretation and provision of clinical advice Design and Research Setting across many clinical specialties.2 Information and com- The study was carried out in the blood bank of a 600-bed munication technology has a critical part to play in this teaching hospital in Sydney, Australia, which provides a net- development. This technology is a central feature of pa- worked blood banking service throughout a large metropolitan thology laboratories, particularly in complex hospital set- area and is involved in the investigation of antibodies and trans- tings reliant on the efﬁcient management of information fusion-related issues. The blood bank has 13 full-time equivalent for patient care.3 staff, including 5 scientists and 8 technical ofﬁcers/assistants. There are also 6 hematologists available on site. It is part of a pathology service made up o
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