Unsolicited vs Solicited POC results

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We currently use unsolicited orders for our ABL90 blood gas analyzers. We have been asked to provide PROS and CONS in changing to solicited orders. What type of orders do most facilities use for their POC Blood Gas testing? If your site utilizes solicited ordering...can you provide any advice in this area?

4 Replies

Janet Royal

Wed Jan 03, 2024 at 7:52AM

We use unsolicited for POCT. If you use solicited, someone (nurse, RTs) will have to order and collect the test in the computer, get the sample ID (via mobile printer) and receive it into the system before running. This workflow would not be the most efficient in the critical care setting and would add alot of additional steps to the process. We actually went live with solicited orders for TEG recently in the OR & CVICU and it has been a learning curve. We have to monitor the outstanding lists in the lab to make sure all of the tests have resulted. It usually happens at night during a crisis where the user forgets to enter all of the collection info properly or doesn't receive it properly and the results are hanging out in neverland.

Erika Deaton-Mohney BS, MT(ASCP), CPP

Wed Jan 03, 2024 at 9:42AM

We use unsolicited for the same reasons that Janet has added. Agreeing that extra steps would need to be added in those critical areas for the testing to be ran on a bidirectional interface, we do not want to impede patient care. The only problem with unsolicited orders is ensuring you are compliant with the accreditation standard for provider orders being placed. For CAP, that is GEN.40700. We are currently going through a long and arduous process of ensuring our unsolicited orders for ABL90 gases actually get the orders placed. That, too, is a journey.

I wonder though, how much impact the change to solicited ordered would be? It appears that our RT department is very good at getting their orders placed in real time for the unsolicited, both in NICU and Trauma Care. It might be a challenge in our Surgery areas if the orders were an order for every test.

Ken Charpie

Wed Jan 03, 2024 at 10:51AM

I would like to go to unsolicited, but the regulatory issues Erika brings up are challenges that would be amplified in ORs and critical situations. On top of those are the issues of repeat testing and duplicate billing, which very quickly becomes nightmarish when staff do not clean up orders and results immediately and must be fixed days later by someone else. I find that non-lab staff are not as tuned-in to reconciling orders/results/billing, and things get messy fast. I've dealt with too many of these problems even with a solicited workflow.

Solicited does create a less-than-ideal workflow, but in emergent situations, results run without an order (ie downtime-ish) will still transfer to our LIS/EHR for association with an order afterwards. This is actually even easier to do than working with receiving an order in the system prior to analysis during the normal solicited workflow.

We do use unsolicited for other, simpler results.
Our RT has used Siemens, Radiometer and Werfen analyzers; all on solicited interfaces. We've never considered unsolicited.

Stephen Wong

Tue Jan 09, 2024 at 4:19PM

Hi Erika,

We are in the same boat in regard to having issues with having provider orders match blood gasses that are run. Is there anything you are doing that is proving to be effective? Maybe a technical solution other than training and retraining?

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Unsolicited vs Solicited POC results