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Nutrition Informatics Blog

Jun

12

What's The Rush?

Submitted by Cathy Welsh, MS, RD

 

Have you ever wondered which is faster: STAT, ASAP, rush, or now? The answer is that it depends on how your facility has defined the processes around these different priorities.

The priority of an order can affect the functionality of the order in your electronic medical record (EMR). For example, an order for a STAT blood draw can print the requisition (request for service) to the nursing unit for the nurse to collect the sample, whereas the blood draw ordered just as “routine” will print to the laboratory department for a phlebotomist to collect during rounds.

The priorities are defined differently for the pharmacy and for patient care orders vs a lab order. For example, medication orders placed as STAT may not print requisitions to the pharmacy at all, but may print on the unit for items that the nurse pulls from the nearby Pyxis MedStation®.

The main message when considering your EMR priorities is that when everything is STAT, nothing is STAT. People should choose the lowest level of urgency appropriate to the request, so that when the situation is emergent, the resources are available to meet that need in the minimum amount of time.

A good example of this is the experience of the Swedish Medical Center of Seattle (Priority-Based Hospital Order System Reduces Percentage of "STAT" Orders and Enhances Response Time—Especially for Clinical Results). This experience was reported on the AHRQ (Agency for Healthcare Research and Quality) Web site, which is part of the US Dept of Health and Human Services.

 

The problem was that physicians entered the majority of orders as STAT, believing that to do anything else would result in lengthy waiting times. This led to a heavy demand of laboratory services, and a lack of responsiveness to “true” stat orders. To resolve the problem, the facility had to define what each priority meant and to determine realistic turnaround times.


These are the three main categories of priorities:

1.STAT=turnaround time of 45 minutes or less. These orders have the highest priority, reserved for life-threatening situations, such as a serious allergic reaction. About 20% of all orders actually are STAT.

2.ASAP=turnaround time of 45 minutes to 2 hours. These “as soon as possible” orders are meant for situations that are not life threatening, but where obtaining the result quickly will have a significant clinical impact or prevent the backup of workflow. For example, all orders placed in the emergency department are considered “ASAP” at a minimum.

3.Routine=up to 8 hours. Routine orders cover laboratory orders or procedures that are obtained at the next most convenient time, taking the patient’s needs into consideration. For example, you can postpone a routine lab until the routine labs are drawn in the morning (4 am) to minimize the amount drawn and the need to stick the patient an additional time.  About 30% to 50% of orders are considered routine.

 

The result was that the number of orders entered as STAT reduced significantly. Overall, results came back more quickly and the length of stay was lowered.

Defining priorities is important. You can flex reports, requisition printing, firing alerts, and other functionalities to vary by priority. Get involved and become a part of any conversations that are happening at your facility. Remember, when everything is STAT, nothing happens very quickly.

 


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