Laboratory Administration
Operations
Phases of the "Loop"

Author: Richard E. Horowitz, M.D. (see Authors page)

Revised: 25 January 2017, last major update June 2013

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: phases of the loop
Cite this page: Phases of the Loop. PathologyOutlines.com website. http://pathologyoutlines.com/topic/managementlaboperationsphases.html. Accessed April 24th, 2017.
Requirements of the Reporting Phase
  • This is the final phase of the "Loop" and consists of: results transfer to the originating information system, to the nursing station, to the patient chart, to the ordering physician's office and to the physician's brain so he can use the information to solve his original problem
  • See Arch Pathol Lab Med 2008;132:1608, Arch Pathol Lab Med 2008;132:84, Arch Pathol Lab Med 2009;133:942
  • This phase requires:
  • A report which may be paper, computer screen, verbal or other
    • Pathology is an information business; our product is information in the form of reports, numbers, graphs, pictures, descriptions and diagnoses
    • Our various report formats are the "gift wrap" for our product; this includes the classical paper report, the telephone report and the report appearing on the computer screen
    • The design of the various report formats is the responsibility of the laboratory working with the clinicians and other customers, e.g., nurses, ward clerks
    • Essentials of a good form
      • Visual appeal - include logo - get design help
      • Easy data entry and readability
      • Customized report formats for different customers
      • Zoning, spacing, sequencing, emphasizing and elimination of unnecessary data
    • Establish a system of forms control
      • If there are too many forms, too much paper, poor readability, filing problems
      • Collect all forms, index and classify them, analyze the need for each form, eliminate, consolidate and redesign the essential forms
    • Pathologists' special reporting functions - the TELEPHONE
      • Call the surgeon and attending physician on all malignant, interesting or strange surgical diagnoses
      • Call attending physician about all new panic values or unusual clinical laboratory test results
    • STAT and critical values reporting
      • Criteria for inclusion and ranges by clinicians
      • Reporting methods: phone, computer, text message
      • Hierarchical escalation of reporting
    • HIPAA
      • Privacy protection standards
Requirements of the Specimen Acquisition Phase
  • This is the next phase; the LIS generates pick-up lists, work lists, billing data, checks for duplicate test orders, duplicate names and checks for appropriateness of order based on Admitting Diagnosis or ICD codes
  • A phlebotomist or nurse obtains specimen and sends it to the laboratory and the specimen is triaged in laboratory central receiving area
  • This phase of the "TEST" has many requirements, most not in, or related to, the laboratory; these include:
    • Patient and specimen identification system (bar code, RFID)
    • Hospital computer system that has the capability for duplicate name check
    • Laboratory computer system that has capability for duplicate test order checking
    • Personnel training for proper specimen acquisition; phlebotomists, nurses, couriers - all need training - particularly nurses and orderlies who are responsible for specimen acquisition, e.g., sputum or urine or ICU specimens from IV lines
    • Special training for personnel outside the hospital, particularly doctor's office personnel, surgicenter personnel, remote outpatient phlebotomy sites, etc.
    • Equipment: computer, cars, pneumatic tubes, bar code printers, phlebotomy carts, robots for specimen transport must all be checked for proper functioning; for example, does the car used by the courier service have appropriate refrigeration for specimens? Does the pneumatic tube system cause hemolysis?
    • Specimen triage in the laboratory's Central Receiving and Processing area is often the source of errors, it requires fail-safe systems and protocols for:
      • Test ordered lists (on paper or on computer)
      • Specimen receipt list
      • Specimen splitting and distribution
      • Work lists
      • Send-out list
      • Overdue test lists
      • Re-draw lists
Requirements of the Testing Phase
  • This is the next phase of the "Test Loop" and the one usually thought of by laboratorians as constituting the "test"
  • Some general requirements are listed below - these obviously differ for the various tests done in the laboratory, but must be kept in mind at all times:
  • Test development and selection requires assessment of clinical utility, cost analysis and comparison, technology assessment, impact on workload, need for information management and employee education and test validation
  • Test performance is dependent on: competent personnel, functioning equipment, adequate space and proper reagents
  • A Standard Operating Procedure (SOP) for every test needs detailed descriptions of:
    • Purpose and principles of the test
    • Specimen requirements
    • Reagents and equipment
    • Testing procedure
    • Calibration
    • Quality control
    • Calculations
    • Interpretation
    • References
    • History of the test in the laboratory
  • Quality assurance (encompassing QA, QC, quality management, proficiency testing, performance measurement, process improvement, outcomes management, etc.) is an essential component of the Testing Phase
  • Point of care and ancillary testing is generally the responsibility of the laboratory and needs special attention with regard to:
    • Justifying the point of care testing
    • Developing simple methods for non-lab personnel
    • Acquiring fail-safe instruments
    • Selecting methods and equipment
    • Training personnel
    • Quality management and proficiency testing
    • Billing
    • Transfer of result data from POC to LIS
  • Pathologist's interpretation and verification is required on all anatomic and selected clinical pathology tests
Billing Subsystem
  • Although not included in the original Lundberg Loop, billing is an essential component of laboratory operations and has many requirements that will be discussed in subsequent chapters on financial management
Requirements of the Reporting Phase

  • Computer interface identical to that described above
  • A report which may be paper, computer screen, verbal or other
    • Pathology is an information business; our product is information in the form of reports, numbers, graphs, pictures, descriptions and diagnoses
    • Our various report formats are the "gift wrap" for our product; this includes the classical paper report, the telephone report and the report appearing on the computer screen
    • The design of the various report formats is the responsibility of the laboratory working with the clinicians and other customers, e.g., nurses, ward clerks
    • Essentials of a good form
      • Visual appeal - include logo - get design help
      • Easy data entry and readability
      • Customized report formats for different customers
      • Zoning, spacing, sequencing, emphasizing and elimination of unnecessary data
    • Establish a system of forms control
      • If there are too many forms, too much paper, poor readability, filing problems
      • Collect all forms, index and classify them, analyze the need for each form, eliminate, consolidate and redesign the essential forms
    • Pathologists' special reporting functions - the TELEPHONE
      • Call the surgeon and attending physician on all malignant, interesting or strange surgical diagnoses
      • Call attending physician about all new panic values or unusual clinical laboratory test results
    • STAT and critical values reporting
      • Criteria for inclusion and ranges by clinicians
      • Reporting methods: phone, computer, text message
      • Hierarchical escalation of reporting
    • HIPAA
      • Privacy protection standards