Patient or specimen identification errors involving the laboratory cause some 160,000 adverse patient events each year in the United States, state the authors of a 2005 College of American Pathologists Q-Probes study.1 Nearly 60% of medical error deaths are reportedly due to patient misidentification; based on this, the Institute of Medicine estimates that in 2004, 114,706 people died as a result of "wrong patient" medical errors.2 Another national study, conducted in the late 1990s, showed that specimen-related errors result in $200 million to $400 million in healthcare expenditures per year in the U.S.3

Given the scope of the problem, it is not surprising that accurate patient identification is number one on the list of the Joint Commission on Accreditation of Healthcare Organizations’ (JCAHO) 2006 Hospital National Patient Safety Goals.4 Against this backdrop, the need for hospitals to address patient misidentification and specimen errors is clear.

Novel technology

Jackson-Madison County General Hospital (Jackson, TN) – a non-profit, 662-bed tertiary care center and the flagship facility of West Tennessee Healthcare – recently took action to improve its specimen collection process. The hospital successfully implemented the latest version of the BD.id Patient Identification System for Specimen Management with wireless capabilities.

Jackson General selected the system based on its impressive track record, including nearly 100 percent reduction in critical specimen errors caused by patient misidentification, and annual cost savings of $165,000 at The Valley Hospital (Ridgewood, NJ). A pre-implementation analysis at Jackson General indicated that the BD.id system would be able to reduce errors in the specimen collection process, cut down on time-consuming blood redraws and lower the cost of delivering medical care."Collecting specimens from patients in a hospital is a very complex process, involving multiple steps and many people. Not surprisingly, there are several touch points where errors can occur," said Ana Stankovic, M.D., Ph.D., MSPH, WW Medical, BD Diagnostics - Preanalytical Systems.

Improved patient identification

The BD.id System is a hand-held computer with a scanner, plus a wireless printer, and it offers wireless communication with the laboratory information system (LIS). The BD.id System gives positive identification by scanning patient wristband bar codes and healthcare professional user ID badges. It also tracks the specimen container and the order of draws.

The hand-held computer is able to receive patient information from the LIS. Information matching is done between the hand-held computer and the patient’s wristband; the information about the patient in the handheld computer is compared with that on the patient’s wristband. Mistakes – such as trying to take samples from the wrong person, or the wrong samples from the right person - can be caught here.

Another important feature of the BD.id System is that it scans the specimen container at the time of collection to ensure that the correct specimen goes in the correct container. Once this has been confirmed, the system prints a bar code label for the specimen container. These instrument-readable labels are printed only for specimens actually collected.

The labels designed to be used with the System have a v-notch cut into the label itself. The label carries order data, patient information, date and time of collection and collector’s ID. The label notch is applied to the patented visual guide technology on BD Vacutainer Plus Plastic Tube to achieve proper placement. This helps reduce misalignment errors, which can cause problems with sample visibility, identification of tube type in the event of removed closure, ability to identify the fill indicator, or inconsistent bar code locations. These issues can create instrumentation readability problems; by avoiding them, the BD v-notch labeling system has great promise in realizing efficiencies in clinical laboratories.

Lean Management, Six Sigma

Before Jackson General implemented the BD.id System, both BD and the hospital focused on improving operations to increase patient safety while reducing costs. Jackson General applied Lean Management (targeting reduction of waste) principles to its phlebotomy processes, including factors such as the layout of blood collection supplies in trays and the set-up of the specimen receipt area. BD consultants used other methodologies such as Failure Mode and Effects Analysis (FMEA) and Six Sigma (targeting reduction in variability) to help the hospital analyze its specimen collection processes. The consultants recommended changes designed to streamline operations, increase staff efficiency, improve quality and patient safety and reduce errors and associated costs. Time-and-motion studies were conducted to eliminate unnecessary, wasteful activities. Finally, using the hospital’s own data, BD consultants performed return-on-investment analyses to determine potential financial benefits of BD.id System.

This pre-implementation analysis was particularly valuable for Jackson General. "We learned that we had a lot of wasted time and non-value added steps in our process and we were not standardized in how each phlebotomist approached the collection process. We were surprised at how many times specimen labels were handled and resorted," said Jamie Boone, B.S., M.T. (ASCP), assistant director, laboratory services, at Jackson General. "Since we had already applied Lean Management principles to our processes, selecting the BD.id System was the next logical step."

In addition, based on a pre-implementation cost-benefit analysis performed by BD and the hospital, Jackson General expects to see a 56 percent return on investment within five years. In fact, the pre-implementation analysis predicted that the BD.id System should pay for itself in roughly two-and-a-half years, and could save the hospital as much as $285,000 over five years.

During implementation, the BD team worked closely with Jackson-Madison Hospital staff to make the process as seamless as possible. Nevertheless, the amount of information that had to be programmed through the laboratory interface - including patient demographics, location, account information and details about which tests have been ordered and taken – posed a challenge. "This complexity made good co-operation essential, and the BD team provided it," said Boone. Implementation was completed in September 2005.

No errors to date

To date, Jackson General’s experience with the BD.id System has been overwhelmingly positive. Phlebotomists have welcomed the new technology, adjusting very quickly to its use. "There is always trepidation when starting out with a new system, but everyone has adjusted well – including those with little previous computer experience. The system is very user-friendly," Boone noted. "The device is easy to use, and has been easy to assimilate into work-flow patterns – despite the fact that the system does a vast amount of work."

According to Boone, useful features of the BD.id System include "positive identification of the patient, with results obtained sooner, because specimens are received in the laboratory more quickly. Laboratory staff have more control over their work, and phlebotomists on the floor get real-time measures; they know which samples are needed, and from which patients, without leaving the floor." An in-depth time measurement study to be carried out early in 2006 - three months after implementation - is expected to provide quantitative measures of benefits.

Most significantly, there have been no documented identification errors at Jackson General since the BD.id System was implemented in September. Boone concludes: "Everything we’ve done seems to have been worthwhile – both in terms of time spent and dollars invested." HPN

2.http://www.fortherecordmag.com/
archives/ftr_011705p34.shtml (January 2005)

3. Bologna L., Hardy G., Mutter M. Reducing specimen and medication error with handheld technology. Presented at: 2001 Annual Conference and Exhibition. Healthcare Information and Management Society; February 4-8, 2001; Chicago, Illinois. (see: http://www.himss.org/content/files/
proceedings/2001/sessions/
ses060.pdf)

4. Source: www.jcaho.org/accredited+
organizations/hospitals/npsg/06_npsg
_cah_hap.htm