CC-UC-02800 - Hospital In-Patient: Basic Flow - Laboratory

Actors

• Patient
• Registered Nurse (RN)
• Laboratory technician
• Microbiologist
• Medical Doctor (MD)
• Consulting specialist
• Pharmacist

Pre-conditions

• The patient has been admitted to the hospital for in-patient care.
• The patient's advanced care planning has been discussed at the time of admission.
• Blood, stool and urine specimens have been collected and labelled in the ED.
• In-patient team has access to emergency department documentation and laboratory results.
• The patient is admitted due to concern of sepsis.

Step	Description	Data elements collected	Result
1	The MD receives and assesses preliminary blood culture results that were drawn at the emergency department. (results typically returned in 48 hours).	Performing Laboratory Modality Laboratory Observation Code Laboratory Test Performed Laboratory Observation Origin Date and Time Laboratory Observation Effective Date and Time Laboratory Observation Value Laboratory Observation Result Interpretation Laboratory Observation Result Status Laboratory Result Note (if applicable) Laboratory Result Review Status Laboratory Result Review Status Author Laboratory Result Review Date and Time	The blood culture results are received and assessed and patients medical record is updated in the hospital information system.
2	The lab technician and microbiologist process and analyze the patient's preliminary culture results.	Performing Laboratory Modality Laboratory Observation Code Laboratory Test Performed Laboratory Observation Origin Date and Time Laboratory Observation Effective Date and Time Laboratory Observation Value Laboratory Observation Result Interpretation Laboratory Observation Result Status Laboratory Result Note Specimen Identifier Specimen Processing Status Date and Time Specimen Lifecycle Stage Specimen Status Specimen Processing Procedure	Laboratory culture results are processed and analyzed and recorded in patient's medical record in the hospital information system.
3	The MD sets a care plan including lab work and treatment.	Service Request Identifier Service Request Category Service Request Name Service Request Reason Service Request Intent Service Request Status Service Request Timing Service Requester Service Request Date and Time Authored On Medication Medication Dose Value Medication Dose Unit of Measure Medication Route of Administration Medication Timing Medication Reason Medication Request Intent Medication Request Authored on Date and Time Medication Request Status	The care plan, laboratory testing, and treatment orders are established, and the patient's medical record is updated.
4	The MD confers with a consulting specialist and pharmacist and adjusts the patient's treatment in response to the preliminary laboratory results.	Consultation/Referral Type Service Request Reason Service Request Status Service Requester Service Request Communication Method Service Request Supporting Documentation Service Request Performer Service Request Performer Type Health Care Provider Specialty and Subspecialty Health Care Provider Role Medication Medication Dose Value Medication Dose Unit of Measure Medication Route of Administration Medication Timing Medication Reason Medication Request Status Medication Request Status Reason Medication Notes	MD consults with specialist to set a course for treatment and the patient's medical record is updated to reflect adjustment to treatment plan in the hospital information system.
5	The lab technician and microbiologist finalize and update culture results and makes the available to the attending in-patient care provider(s).	Performing Laboratory Modality Laboratory Observation Code Laboratory Test Performed Laboratory Observation Origin Date and Time Laboratory Observation Effective Date and Time Laboratory Observation Value Laboratory Observation Result Interpretation Laboratory Observation Result Status Laboratory Result Note Laboratory Result Sent To	The patient's culture results are updated, finalized and made available to the attending in-patient care provider(s) and recorded in the patient's medical record in the hospital information system.
6	The MD reviews the laboratory results, consults with the pharmacist and infectious disease specialist , and updates the patient's treatment plan based on the specialist recommendations.	Laboratory Result Review Status Laboratory Result Review Status Author Laboratory Result Review Date and Time Consultation/Referral Type Service Request Reason Service Request Status Service Request Performer Service Request Performer Type Health Care Provider Specialty and Subspecialty Health Care Provider Role Medication Medication Dose Value Medication Dose Unit of Measure Medication Route of Administration Medication Timing Medication Reason Medication Request Status Medication Request Status Reason Medication Notes	The patient's treatment plan is updated, and the patient's medical record is updated in the hospital information system.
7	The patient receives ongoing treatment, resulting in resolution of the health concern.	Medication Medication Dose Value Medication Dose Unit of Measure Medication Route of Administration Medication Administration Status Medication Administration Role Type Medication Administration Date and Time Medication Notes Health Concern(s) Health Concern Clinical Status Health Concern Date of Resolution	The patient is treated and the health concern is resolved and recorded in the patient's medial record in the hospital information system.
8	The patient is discharged to home and encounter details are shared with the patient's primary care provider.	Encounter Status Encounter End Date and Time Encounter Disposition Document Date and Time Document Status Document Principal Author Document Type Document Recipient Document Content	The patient is discharged to home, the encounter details are shared with the patient's primary care provider, and the patient's medical record is updated to reflect the discharge.
9	The hospital notifies the public health unit of the infectious disease in accordance with provincial or territorial reporting requirements.	Laboratory Result Sent To Laboratory Result Note Result Reported to Public Health Flag Document Date and Time Document Status Document Type Document Recipient Document Content	The public health unit it notified as needed accordance with provincial or territorial reporting requirements.
10	This use case ends.	Not applicable	Not applicable

Post-conditions

• The patient's blood culture results are received and assessed.
• Patient treatment plan is invoked until the health concern is resolved.
• The patient is discharged to home.
• The patient's encounter details are shared with the primary care provider.
• The public health unit it notified as needed accordance with provincial or territorial reporting requirements.
• The patient's medical record is updated.

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If you have questions about this initiative, would like to be added to our stakeholder notification list or would like to participate in our consultations, please email us.

connectedcare@cihi.ca