Using the patient csn vs accession number in RALS

Can I ask WHY they want to make this decision?

Our accession numbers are "reused" after a time period, so we do not have this as an option.  We are currently using the Account Number (HAR) but are looking to move to CSN instead.

Our EPIC team recently made an upgrade and discovered many POC orders in an error queue that were unresolved because no result ever posted to close the loop. Apparently, this is connected to how the nursing POC test request notification was originally set-up. I was not in POC at that time and everyone who part of the original build is gone. We are now trying to figure out how to resolve the problem.

The key is if the orders are solicited or unsolicited.  Solicited orders will often need to use the accession number due to its specificity of the tests requested, whereas unsolicited orders is often used when there is a PRN and is used when there is need to monitor the patient, such as glucose testing.  Most unsolicited orders are resolved in EPIC because it creates the order and fills in the result.  The solicited orders are where there is a request and an accession number in the lab is generated to handshake with the EPIC order.  Some solicited orders are created, but through the LIS the results come back like an unsolicited result, causing a pending queue in EPIC.

Hi Maureen,

We have the same issue. We are using EPIC enter/edit with RALS. They switched to adding CSN numbers with Aztec square barcodes on patient wristbands and we every now and then have issues with the results not being able to match to a patient encounter. We have to go into EPIC, search for the patient account number and change the result patient ID to the patient account number manually.  Then we can assign the result to the order and send to EPIC.

We also have several devices such as our Cobas Liat, Radiometer ABL90 and Hemochron that can only take the account number so our operators have to print special wristband labels with the linear barcode reflecting the account number.  

Overall expect this to increase your workflow workload and I hope you have a coordinator to monitor the flagged results list, especially if you have a solicited interface. Feel free to reach out any time bmforsythe@ucdavis.edu.

Echo what Michael L. said.  Speaking very generally here, moving POC testing to using accession numbers (with the assumption that also means using solicited orders) adds complexity to the testing process to the operators, in that there is usually a need to locate the appropriate order to match the result against, rather than just performing the test.  I'd strongly advise against if there is any operator responsibility in identifying the appropriate order for each testing event.