'Who's Covering This Patient?' Developing a First-Contact Provider (FCP) Designation in an Electronic Health Record.

BACKGROUND: Safe and efficient inpatient care depends on accurate identification of the licensed independent practitioner (LIP) primarily responsible for each admitted patient. The inability to do so has far-reaching consequences, including poor communication among care teams, delays in patient care (including critical result reporting), and significant threats to patient safety. METHODS: At the University of Chicago Medical Center, an 800-bed academic hospital, a new Epic feature, called First-Contact Provider (FCP), was developed to identify the responsible LIP for each inpatient. The number of patients with only one designated FCP at a given time was audited daily. To ensure correct technical function, the number of Best Practice Advisories (BPAs) alerting of no documented FCP was measured. The number of inpatient critical lab values reported directly to LIPs was measured as a proxy for the accuracy of FCP in identifying the correct LIP. RESULTS: During the nine-month study period, the average daily inpatient census was 568 and the average monthly critical lab volume was 1,727. By the end of the study, the weekly mean percentage of patients with one FCP documented at noon reached 98.6%. The weekly mean number of BPAs dropped from 5,313/day to less than 50/day. The monthly mean percentage of critical results reported directly to LIPs increased from a pre-FCP baseline of 18.0% to 87.8%. CONCLUSION: FCP largely solved the far-reaching problem of accurate LIP identification for hospitalized patients. This, in turn, significantly improved the ability to report inpatient critical lab values directly to LIPs.

Effect of blood collection tubes on the incidence of artifactual hyperkalemia on patient samples from an outreach clinic.

BACKGROUND: An offsite satellite clinic of the University of Chicago Medical Center (UCMC) requested an investigation by the Clinical Chemistry Laboratory (CCL) into several cases of possible falsely elevated potassium (K⁺) values in their patients. Bloods for K⁺ and chemistry profiles are routinely collected in mint-green, heparinized plasma separator tubes (PST), centrifuged, and transported by courier from satellite clinic to CCL within several hours. Samples from on-site phlebotomy areas are similarly collected but sent uncentrifuged to CCL via a pneumatic tube system within minutes of collection. METHODS: Our investigations included extensive QC and QA review of UCMC onsite and offsite outpatient clinics, reference range studies using PST and serum separator tubes (SST), assessment of pre-analytic handling of specimens, including transportation simulation study, and comparison of K⁺ results for samples collected simultaneously using PST and SST tubes at an offsite clinic. RESULTS: Our transportation simulation demonstrated elevations in K⁺ concentrations following sample jostling and perturbations. We also observed RBC escape across the gel barrier further contributing to K⁺ elevations. CONCLUSION: Serum is preferred sample type for an offsite clinic.