It’s prudent to be a bit pessimistic about your computer systemand to consider what will happen if it lets the laboratory down.
Asimple, workable backup plan is imperative in the event of computerfailure. Start with a daily routine that will enable you to retrieveinformation on pending work any time access to the computer is lost. Inour 518-bed hospital laboratory, elements of such a routine include: * Computer-generated collection summaries, noting when blood is tobe drawn, from which patients, and for what tests. The summaries,printed every four hours, are kept in our laboratory data center, whichreceives test requests and specimens and distributes them to the varioussections.
As test requests arrive in the lab, they are placed in a tray forcomputer entry and not filed away until the next summary is printed.Between the unfiled requests and the summaries, we can easily tell whatblood work remains to be drawn if the system goes down. * Section logs.
Each section has special printing times for logsof all tests ordered in its area and their status. Also printed is alist of results that have to be verified. * Census reports. These list inpatients and outpatients, thelatter kept on the daily reports for five days after their last visit oruntil lab work is completed. Patient ID numbers, room numbers,attending physicians, and other printed details can help us fill ininformation gaps on test requests. A special downtime box in each section contains backup plans andforms to be used when the computer is inoperative.
One copy of each labtest report goes into this box during downtime, so we can keep track ofall completed work that has not been entered into the computer. Our laboratory minicomputer is not tied into the hospital mainframefor request and reporting purposes. If it were, we would notify thehospital information system by phone about any serious computer problemin the laboratory. We would also inform all nursing service units, byphone or hospital PA system, to let them know their CRTs could not callup lab results. As things stand, we just have to notify all areas of thelaboratory.
They would be told whether the system is expected to bedown less than six hours, in which case backup plan A takes effect, orfor a longer period of time (backup plan B). The main difference between the two plans is that, once thecomputer is operational again, all results are entered into it ifdowntime has lasted less than six hours. A lengthier downtime requiresus to place manually prepared reports on patient charts.
This is doneevery four hours by charting clerks. The original test request withresults filled in is stamped “final copy, do not remove” andbecomes part of the patient’s hospital record. Two copies are made– one placed in the laboratory data center downtime file for possiblefuture reference, the other used for billing purposes. Computerized results are normally conveyed via two ward summaryreports a day, printed at about 10 a.m. and 5:30 p.m.
, and an earlymorning cumulative summary on each patient. With downtime of six hours or less, the buildup of results is notso overwhelming that we cannot get them all into the computer when it isback up. Microbiology and urinalysis use mark sense cards. In thosesections, it’s just a matter of putting the cards into a reader.
Other sections write the results on the test request forms and enter therequests and the results at the same time when the system is workingagain. All Stats and critical values are called to nursing serviceunits. Such batch work as chemistry screens and complete blood counts isdone on analyzers that are interfaced to the laboratory computer, andresults are automatically entered into the system. We therefore try tohold off on these tests until we determine whether the computer will beoperational within six hours.
Every two hours during downtime, copies of a manual log of incomingtest requests, organized by section, are distributed throughout thelaboratory. Each section can then check if it has received all of itswork or if work is still pending. As soon as the system is live again,before any data are entered or retrieved, we call up a collectionsummary. This is checked against our manual log to insure completion ofall work and to avoid duplication. Phlebotomy ordinarily uses our computer-printed tube labels as adrawing list. When the computer is down, it receives the original testrequests. If any hamaatology work is ordered, we also give phlebotomy aspecial request form with spaces for CBC findings and other results, tobe manually filled in as testing is performed.
This form is taken to thenursing service unit, which stamps it with the patient’s ID. When a specimen is collected, it is sent along with the request tothe laboratory section that will perform the tests. If several sectionsare involved, the request first goes to chemistry, which usually has themost work. Chemistry fills in its results on the request, then passesit on to the next section.
On early morning draws, all requests are organized by hospitalarea, and a log is written up. Copies go to the nursing service unitsand lab sections. By the way, a reliable copying machine is another keybackup element. We have had to use backup plan A several times since we installedthe laboratory minicomputer nearly two years ago. Each time, the labcontinued to run smoothly. Plan B was pressed into service only once,when we increased the computer’s memory from 128K to 192K.
Thecomputer was down 15 hours, and even in all that time, there were noproblems.