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Design, Development, and Evaluation of a Laboratory Order Entry and Results Review Application for a Low-Resource Inpatient Setting

Mtonga, Timothy M (2020) Design, Development, and Evaluation of a Laboratory Order Entry and Results Review Application for a Low-Resource Inpatient Setting. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Estimated to be the basis of up to 70% of all clinical decisions, laboratory testing is an important component of the clinical diagnostic process. However, the laboratory testing process is often negatively affected by events that delay or prevent laboratory tests from being performed or the results of those laboratory tests from being utilized in the clinical context i.e. laboratory errors. While laboratory errors are ubiquitous across health facilities, low-resource settings are particularly susceptible to high incidence rates due to shortage of both human and material resources, frequent power outages, and inadequate infrastructure to meet the demand of laboratory testing in these settings.
Appropriate application of technology provides opportunities for reducing the occurrence of laboratory errors by addressing gaps in the laboratory testing process. To this end, we conducted a series of studies at Kamuzu Central Hospital, a referral hospital in the central region of Malawi, a low-income country. These studies were conducted to understand the laboratory testing process in this setting, identify the gaps in the laboratory testing process that could cause specimens to not be analyzed due to various reasons for non-viability, and measure the magnitude of specimen rejections and the reasons for rejection. We then designed and implemented two interventions aimed at reducing the number of specimens rejected as being non-viable for testing. First, we deployed a specimen collection cart with a paper job aid to address gaps in knowledge during specimen collection. The second intervention was an electronic system designed to support the process of ordering laboratory tests and collecting specimens. Both interventions were evaluated to assess their impact on the rates of specimen non-viability.
We assert that this research contributes to knowledge in several ways. First, it provides descriptions of the current laboratory testing process and its gaps. We provide accurate and current measures of the magnitude of specimen rejection rates in this setting. Third, we describe our experience implementing the first clinician facing system in the inpatient setting at Kamuzu Central Hospital. Lastly, all software and hardware developed in this study is freely available for customization and use in other health care settings.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Mtonga, Timothy Mtimmtonga@gmail.comtmm1130000-0002-2526-4243
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDouglas, Gerald P.gpd6@pitt.edugpd60000-0003-3333-7251
Committee MemberEspino, Jeremyjuest4@pitt.edujuest40000-0001-8104-2656
Committee MemberLandsittel, Douglasdpl12@pitt.edudpl12
Committee MemberHarry, Hochheiserharryh@pitt.edu
Date: 11 May 2020
Date Type: Publication
Defense Date: 6 April 2020
Approval Date: 11 May 2020
Submission Date: 17 April 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 173
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Biomedical Informatics
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Low-resource setting, Laboratory testing, Specimen non-viability, CPOE
Date Deposited: 11 May 2020 12:06
Last Modified: 11 May 2020 12:06
URI: http://d-scholarship.pitt.edu/id/eprint/38743

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