It’s prudent to be a bit pessimistic about your computer system
and to consider what will happen if it lets the laboratory down. A
simple, workable backup plan is imperative in the event of computer
Start with a daily routine that will enable you to retrieve
information on pending work any time access to the computer is lost. In
our 518-bed hospital laboratory, elements of such a routine include:
* Computer-generated collection summaries, noting when blood is to
be drawn, from which patients, and for what tests. The summaries,
printed every four hours, are kept in our laboratory data center, which
receives test requests and specimens and distributes them to the various
As test requests arrive in the lab, they are placed in a tray for
computer entry and not filed away until the next summary is printed.
Between the unfiled requests and the summaries, we can easily tell what
blood work remains to be drawn if the system goes down.
* Section logs. Each section has special printing times for logs
of all tests ordered in its area and their status. Also printed is a
list of results that have to be verified.
* Census reports. These list inpatients and outpatients, the
latter kept on the daily reports for five days after their last visit or
until lab work is completed. Patient ID numbers, room numbers,
attending physicians, and other printed details can help us fill in
information gaps on test requests.
A special downtime box in each section contains backup plans and
forms to be used when the computer is inoperative. One copy of each lab
test report goes into this box during downtime, so we can keep track of
all completed work that has not been entered into the computer.
Our laboratory minicomputer is not tied into the hospital mainframe
for request and reporting purposes. If it were, we would notify the
hospital information system by phone about any serious computer problem
in the laboratory. We would also inform all nursing service units, by
phone or hospital PA system, to let them know their CRTs could not call
up lab results.
As things stand, we just have to notify all areas of the
laboratory. They would be told whether the system is expected to be
down less than six hours, in which case backup plan A takes effect, or
for a longer period of time (backup plan B).
The main difference between the two plans is that, once the
computer is operational again, all results are entered into it if
downtime has lasted less than six hours. A lengthier downtime requires
us to place manually prepared reports on patient charts. This is done
every four hours by charting clerks. The original test request with
results filled in is stamped “final copy, do not remove” and
becomes part of the patient’s hospital record. Two copies are made
— one placed in the laboratory data center downtime file for possible
future reference, the other used for billing purposes.
Computerized results are normally conveyed via two ward summary
reports a day, printed at about 10 a.m. and 5:30 p.m., and an early
morning cumulative summary on each patient.
With downtime of six hours or less, the buildup of results is not
so overwhelming that we cannot get them all into the computer when it is
back up. Microbiology and urinalysis use mark sense cards. In those
sections, it’s just a matter of putting the cards into a reader.
Other sections write the results on the test request forms and enter the
requests and the results at the same time when the system is working
again. All Stats and critical values are called to nursing service
Such batch work as chemistry screens and complete blood counts is
done on analyzers that are interfaced to the laboratory computer, and
results are automatically entered into the system. We therefore try to
hold off on these tests until we determine whether the computer will be
operational within six hours.
Every two hours during downtime, copies of a manual log of incoming
test requests, organized by section, are distributed throughout the
laboratory. Each section can then check if it has received all of its
work 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 collection
summary. This is checked against our manual log to insure completion of
all work and to avoid duplication.
Phlebotomy ordinarily uses our computer-printed tube labels as a
drawing list. When the computer is down, it receives the original test
requests. If any hamaatology work is ordered, we also give phlebotomy a
special request form with spaces for CBC findings and other results, to
be manually filled in as testing is performed. This form is taken to the
nursing service unit, which stamps it with the patient’s ID.
When a specimen is collected, it is sent along with the request to
the laboratory section that will perform the tests. If several sections
are involved, the request first goes to chemistry, which usually has the
most work. Chemistry fills in its results on the request, then passes
it on to the next section.
On early morning draws, all requests are organized by hospital
area, and a log is written up. Copies go to the nursing service units
and lab sections. By the way, a reliable copying machine is another key
We have had to use backup plan A several times since we installed
the laboratory minicomputer nearly two years ago. Each time, the lab
continued to run smoothly. Plan B was pressed into service only once,
when we increased the computer’s memory from 128K to 192K. The
computer was down 15 hours, and even in all that time, there were no