The Critical Result workflow provides patient testing results with critical levels in alert notifications to specified caregivers.
The facility identifies the critical values for specific lab/radiology/pharmacy results. Vocera receives lab/radiology/pharmacy events in the HL7 feed from the EHR, or directly from the lab/radiology/pharmacy HL7 feed. Vocera filters the HL7 feed for results or findings with critical values, which trigger a rule to incorporate the results and patient information in an alert notification message to send to configured recipients.
A physician orders lab/radiology/pharmacy tests or procedues for a patient upon admission to the facility. The lab/radiology/pharmacy group runs the ordered test and enters the result in the system. The assigned nurse receives the critical lab/radiology/pharmacy result in a message that incorporates the patient details. The nurse can add the physician directly to the patient's care team communication, if the physician is using Vocera's Vina app.
This critical result workflow generally results in a change in medication, or a change in care plan. The effect is to improve reliability of delivery to the physician, reduce time required tracking critical lab results, and adds up to improving the delivery of care.
Workflow Example
In this workflow you may note that HL7 is used to input data, and XMPP to output notifications. Other protocols could be used in these scenarios. Vocera provides multiple input and output adapters, as well as adapters to integrate with specific third party vendors.
As shown in this diagram, the workflow begins when the Lab Tech enters a critical lab result in the Laboratory Information System (LIS). The LIS sends the critical lab result to the EMR and the HL7 processor forwards the critical lab result to the Vocera Platform in the HL7 feed. The Vocera HL7 Adapter then saves the critical lab result to the Labs dataset. Vocera filters for A (Critical) or AA (Extremely Critical) flags in the OBX.8 segment for the critical lab results.
Vocera intelligently identifies the covering nurse. A third party On Call System can synchronize assignment data withVocera. The Vocera OnCall Adapter saves the assignment data to the Assignments dataset. The Labs dataset contains the escalation rules that use the Assignment dataset to identify the recipient of the critical lab result notification.
Notifications are sent to recipients connected to the system by one of the Vocera outbound adapters, such as the following:
- VMP Adapter for Voice Badge, SmartBadge, and/or VCE on Smartphone
- XMPP Adapter for Vina
- Outgoing WCTP Adapter for Epic Rover
- SMTP Adapter for email
Vocera sends a preliminary notification to the covering nurse. The notification is delivered to the mobile device, and then accepted by the recipient, the covering nurse. When the notification status is Accepted, Vocera takes the Lab Techs contact number from the HL7 feed, and creates a new button on the nurse's phone to allow them to initiate a voice call to the lab. Vocera also creates an enhanced Caller ID that displays in a popup on the lab's desktop phone, so the lab can identify the incoming call from the covering nurse.
The new button allows the nurse to perform a "Read Back" step to verify the critial lab result. The nurse presses the new button on their device to call the lab tech, and validates the test result with the lab tech before forwarding the result to the physician. The nurse may ask if there were any anomalies in the test or result, or any reason to do a retest.
Once validated, the nurse then forwards the critical lab result to the responsible provider, usually the ordering physician. The physician receives the lab result notification on their phone or communication device. When the ordering physician acknowldeges or accepts the notification, they take responsibility for the critical lab result, and that completes the workflow process.
