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Table 3 Results of interviewing medical specialists

From: Does electronic clinical microbiology results reporting influence medical decision making: a pre- and post-interview study of medical specialists

 

Pre-implementation

Post-implementation

 

Medical specialty

(no. of interviewees)

Description of requesting practice

Use and meaning of results reporting

Problems/Expectations

Results reporting; impact of electronic reporting

Suggestions for improvement

Other remarks

General surgery (1)

Indication based requesting. In OR sampling and clinical data by surgeon, in wards and ER by resident.

Final results are hardly looked at, have in 95% of cases no effect on treatment decisions. Phone calls by CL rare.

/Occasional, selective viewing.

Fast, selective viewing of results.

 

Epidemiological research in cooperation with CM would be useful.

ICU medicine (2)

Indication based requesting by clinician, protocol based requests by nurse.

First results come in from CM by telephone and at daily conference at ICU with CM present.

Final hardcopy results less important.

Tracking of requests impossible. Often incomplete recording of oral consultation in medical record./Daily consulting must remain, also when results in EMR.

Still most information through daily meeting and telephone reporting by CM. No real changes in workflow. Complete and easier patient overview in EMR.

Preliminary results in EMR.

Close communication with CM must remain.

Infectiology (1)

Indication based requesting. Forms by clinician, sampling by nurse.

Therapy starts before results are available. Telephone reporting of relevant information by CM; phone calls for preliminary results mostly by residents.

Hardcopies are always seen.

Occasionally results telephoned by CM misinterpreted by residents./Reports of every intermediate stage in culture workup.

Preliminary results still telephoned by CM, still many phone calls by CL.

End to paperwork. Better overview. Review function important. No more double requests.

Electronic reporting of any interim result!

Possibility to click away read results.

 

Internal medicine (1)

Mostly indication based requesting.

Sampling and forms by both clinician and nurse.

Telephone reporting of relevant information by CM; CL calls if necessary.

Delay in hardcopy delivery. Often hardcopy reports lay unattended for some time./Preliminary results (first growth) in EMR: fewer phone calls necessary.

Fewer phone calls by CL. Faster workflow. Easier access; better overview. Request marked as pending is appreciated. System commands disciplined viewing.

Possibility to perform epidemiology.

Implementation of complete electronic communication with GPs.

 

Neonatology (2)

Both protocol and indication based requesting. Sampling and forms by both clinician and nurse.

Telephone reporting of relevant information by CM; many phone calls by CL for preliminary results. Stat request if necessary. Final results mainly used for follow-up and epidemiology.

TATs and logistics for sending results; delay in hardcopy delivery./Overview in EMR. Retrospective analysis of data. Possibility to perform epidemiology.

Still many phone calls by CL. Better overview of patient data. Patient information easier to find and retrieve.

Shorter TATs. Preliminary results in system.

Usability of EMR system: many pages; layout. Trending is still difficult. Cumulative overview per patient.

Bedside access of patient data.

PDMS on wish list.

Age related background information with final results would be useful.

 

Pre-implementation

Post-implementation

 

Medical specialty

(no. of interviewees)

Description of requesting practice

Use and meaning of results reporting

Problems/Expectations

Results reporting; impact of electronic reporting

Suggestions for improvement

Other remarks

Oncology (1)

Both protocol and indication based requesting. Sampling and forms by both clinician and nurse.

Telephone reporting of relevant information by CM; CL calls if necessary. Once weekly conference with CM present. Final results rarely affect treatment. Hardcopy results that have no consequences usually thrown out. TAT's no problem.

Tracking of requests impossible. Logistics of keeping paper written results./Reduction of paper. Historic overview of results in EMR. Possibility to perform epidemiology.

Relevant preliminary results still telephoned by CM, phone call by CL quicker than electronic report. Disciplining of reviewing data. Better reviewing. No more lost reports. Integral overview of patient. Viewing possible at any workstation.

Usability: EMR system is slow; layout of results.

Important results should be marked.

 

Orthopaedic surgery (1)

Indication based requesting. Sampling by surgeon, forms by nurse except in OR.

Hardcopy reports arrive in mailbox. Therapy started when specimen was taken. In case of urgency phone call by CL.

Delay in hardcopy delivery; problems with reporting over weekends./Integral overview of all diagnostic testing including clinical microbiology.

Quicker availability of results, so fewer calls by CL for final results. Still need for preliminary results. Better reviewing and overview. Administrative time saved.

Request marked as pending is appreciated.

Usability.

Regular meeting on complications with CM present.

Paediatrics (1)

Indication based requesting by clinician.

Sampling mostly by nurse.

Telephone reporting of relevant information by CM. Therapy only changes if result contradicts expectation. Once weekly conference with CM present.

Logistics: large number of hardcopy results. All reports are seen by paediatricians though, chance of missing results small. Availability of results takes too long./Easy access to results in EMR. Better overview. Historical results easier to retrieve.

Fewer phone calls by CL. Availability of results and patient data at large good. Better logistics and faster reporting. No more lost reports. Administrative time saved.

Cumulative overview per patient.

 

Pulmonology (1)

Indication based requesting. Sampling by resident or nurse, because sometimes difficult to time.

Clinical insight (experience) takes precedence over results. Usually no need for fast reporting. Phone call or stat request (Gram stain) in case of urgency by CL.

Hardcopy filing and locating. Results sometimes remain unseen./Better retrospective analysis. Better logistics. Possibility of susceptibility trend analysis.

System not used frequently. Convenient reviewing, convenient overview, even helps prevent errors.

No trending.

Important results should be marked.

 

Urology (1)

Indication based requesting. Sampling by patient, chemistry lab or nurse.

Preliminary results important to start treatment. Phone calls by CL. Hardcopies are always seen.

Difficult to get integrated picture. Delay in hardcopy delivery./Integral overview of patient information including results of requests by GP or other specialty.

Phone calls by CL only for therapy advice. Daily viewing of results. Request marked as pending appreciated; no more double requests. No more lost reports. Integral overview of patient. Viewing possible at any workstation.

  
  1. CL, clinician; CM, clinical microbiologist; ER, emergency room; PDMS, data management system explicitly developed for use in paediatric and neonatal intensive care units.