6679 Auto-filing: giving consultants the gift of time

Objectives Our Emergency Department (ED) SOP for the management of investigations is informed by the Royal College of Emergency Medicine.¹ Consultants are responsible for filing (and actioning) all electronically reported laboratory results. A significant proportion of results are normal therefore time is taken to review normal results rather than apply clinical skills. Due to high volumes of normal results to review it can be difficult to identify an abnormal result – a patient safety risk. This quality improvement project aimed to implement an automated electronic filing process to correctly identify and file normal results, leaving only the abnormal results to be reviewed, clinically actioned, and filed. Methods A pilot project was completed to assess impact. ICE algorithms were designed sequentially to automatically file normal haematology, biochemistry, and certain microbiology results respectively. Prospective data collection took place for two weeks after introduction of each new algorithm, to assess the effectiveness and safety. Consultants continued to manually review all results during each test phase. Queries regarding any results being filed incorrectly were flagged immediately. Algorithms were adjusted until a safe and robust system was running with no queries. Results Pilot data over a 2-week period demonstrated that a potential 93% of selected microbiology swabs, 46% of urine cultures, 17% of haematology and 44% of biochemistry results could be auto-filed. Post-implementation data demonstrated 91% of swabs, 46% of urine cultures and 17% of haematology results were appropriately auto-filed. Biochemistry data showed 43% were auto-filed, however, 8% of these were auto-filed incorrectly due to lack of normal reference ranges for certain tests (for example, carbamazepine levels). Following several improvement cycles, the latest data (July 2023) demonstrates a safe auto-filing system that reduced overall consultant workload by 53%. Conclusion This aspirational project looked to achieve significant reduction in administrative consultant workload. We have designed and maint1ained a safe and robust auto-filing system for ED haematology and microbiology reports. As less time was taken on administrative tasks, 100% of consultants were released earlier to the shop floor; therefore, we increased clinical capacity without investment in staff. All ED consultants provided positive feedback; they found the system focused their mind on the abnormal results. We are disseminating the use of the programme between departments (initially General Paediatrics) with the aim of maximising efficiency of ICE report filing across the Trust. The process can be replicated between Trusts to support time deprived clinicians across the country. References Management of Investigation Results in the Emergency Department – Best Practice Guidance, The Royal College of Emergency Medicine, May 2020