Effects of electronic laboratory ordering on Emergency Department process efficiency

Abstract

Emergency Department crowding is a complex problem with associated patient mortality. Solutions include eliminating bottlenecks in care processes to improve emergency department (ED) capacity, flow and crowding. Since every one minute reduction in laboratory turnaround times shortens individual ED length of stay (LOS) by 30 seconds, reducing the time interval from ordering laboratory tests to results becoming available could contribute to incrementally reducing overall LOS.

St. Vincent’s University Hospital (SVUH) Emergency Department changed from paper-based laboratory orders to electronic ordering (OCS) on 09/05/2023. We conducted a focused pre- and post-implementation evaluation of the effect of this change using two convenience samples of 50 ED patients who required haematology laboratory tests over the first week in March 2023 and 2024 respectively. Patients were selected retrospectively and randomly from routine, extended day and on-call hours across each seven-day period, excluding those where a collection time was unrecorded, add on-requests, or requests ordered by inpatient teams. Times tests were requested, received and resulted from the laboratory system were manually matched with the times each patient was registered, triaged, seen by a clinician, referred if relevant, and admitted or discharged. Time intervals were presented as medians (interquartile ranges) as the data was non-parametrically distributed. No other process changes occurred during the periods evaluated.