Background Critical results consist of laboratory test results that require immediate intervention or decision-making by the responsible medical team, as they pose a risk to the patient's life. To manage the process of communicating critical results, it is also necessary to define the indicators, goals and systematic comparability through benchmarking. Methods The performance of the indicators measuring the critical results process for the year 2023 was analyzed. Performance indicators such as resolution time, success and failure rate in communication, delay rate in communication and the rate of open incidents related to the communication of critical results were monitored using a Business Intelligence tool. Results In the first two months of 2023 the results reflected the absence of parameters in the LIS for effective communication of critical results. September and October there was a high turnover rate in the laboratory in addition to the change in the hospital care profile in which the laboratory medicine service was inserted. These causes culminated in a number of 122 (1.48%) communication failures, representing an increase of 1,120% compared to the first two months of the year. On the other hand, there was a significant improvement in the average communication time for critical results, decreasing from approximately 736 hours to 184 hours(reduction of around 75%). There was also a reduction in communication delay of approximately 67%. These numbers corroborate the parameterization actions in the system aimed at speeding up the process. As a continuation of the improvement actions, the laboratory implemented goal setting for the resolution time indicator and also the periodic meeting for critical analysis of the results.In addition to these actions, the laboratory approached the hospital's clinical staff, making it possible to provide clarity on the difference between compulsory notification and critical results. This clarification allowed for the establishment of a list of exams considered critical, in order to meet the hospital profile, as well as to define the communication flow. For the success indicator in communicating critical results, there was a 22% improvement when comparing the last two months of 2023 with the first two months of the same year. In the last two months of the year, this indicator performed at 99.4%, corroborating the study published by Noronha et al., (2016), where the effectiveness rate in critical results communication was 96.1%. Comparing with the study by Noronha et al., (2016), where the biochemistry sector had the highest rate of critical results communication failures (73.8%), followed by the Emergency Room (78.6% ) and ICU (16.7%), the findings of this study highlighted the top 3 detracting sectors: Biochemistry (68%), “UPA” - Emergency Care Unit (42.1%) and ICU (21.4%), making data superimposable. Conclusions The communication of critical results has challenges related to its effectiveness, especially in hospital contexts. As a critical and high-impact activity, constant actions are necessary to continuously improve the process. Actions should take into account: interactions with attending physicians, the development and training of the internal team, and constant checks of the LIS, as technology can support the process management.

中文翻译：

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A-192 传达关键结果的有效性：技术和咨询行动对改善巴西东北部实验室绩效指标的影响


背景 关键结果包括实验室测试结果，需要负责的医疗团队立即干预或做出决策，因为它们对患者的生命构成风险。为了管理关键结果的沟通过程，还需要通过基准测试来定义指标、目标和系统可比性。方法对2023年衡量关键结果过程的指标绩效进行分析。使用商业智能工具监控解决时间、沟通成功率和失败率、沟通延迟率以及与关键结果沟通相关的开放事件率等绩效指标。结果 2023 年前两个月的结果反映出 LIS 中缺乏有效沟通关键结果的参数。九月和十月，除了插入检验医学服务的医院护理概况发生变化外，实验室的流动率也很高。这些原因最终导致通讯故障 122 起（1.48%），与今年前两个月相比增加了 1,120%。另一方面，关键结果的平均沟通时间显着改善，从大约 736 小时减少到 184 小时（减少约 75%）。通信延迟也减少了约 67%。这些数字证实了系统中旨在加快流程的参数化操作。作为改进行动的延续，实验室实施了解决时间指标的目标设定，并定期召开会议对结果进行严格分析。除了这些行动之外，实验室还与医院的临床工作人员进行了接触，从而能够明确强制通知和关键结果之间的区别。这一澄清允许建立一份被认为至关重要的检查清单，以满足医院的概况，并定义沟通流程。对于传达关键结果的成功指标，2023 年最后两个月与同年前两个月相比，提高了 22%。今年最后两个月，该指标的执行率为 99.4%，证实了 Noronha 等人（2016）发表的研究，其中关键结果沟通的有效率为 96.1%。与Noronha等人（2016）的研究相比，生化部门关键结果沟通失败率最高（73.8％），其次是急诊室（78.6％）和ICU（16.7％），结果这项研究的重点突出了排名前 3 的不利因素：生物化学 (68%)、“UPA”- 急诊室 (42.1%) 和 ICU (21.4%)，使数据可以叠加。结论 关键结果的沟通存在与其有效性相关的挑战，尤其是在医院环境中。作为一项关键且影响深远的活动，需要不断采取行动来不断改进流程。行动应考虑：与主治医生的互动、内部团队的发展和培训以及 LIS 的持续检查，因为技术可以支持流程管理。