A backup plan for computer failure.
Start with a daily routine that will enable you to retrieve information on pending work any time access to the computer is lost. In our 518-bed hospital laboratory, elements of such a routine include:
* Computer-generated collection summaries, noting when blood is to be drawn, from which patients, and for what tests. The summaries, printed every four hours, are kept in our laboratory data center, which receives test requests and specimens and distributes them to the various sections.
As test requests arrive in the lab, they are placed in a tray for computer entry and not filed away until the next summary is printed. Between the unfiled requests and the summaries, we can easily tell what blood work remains to be drawn if the system goes down.
* Section logs. Each section has special printing times for logs of all tests ordered in its area and their status. Also printed is a list of results that have to be verified.
* Census reports. These list inpatients and outpatients, the latter kept on the daily reports for five days after their last visit or until lab work is completed. Patient ID numbers, room numbers, attending physicians, and other printed details can help us fill in information gaps on test requests.
A special downtime box in each section contains backup plans and forms to be used when the computer is inoperative. One copy of each lab test report goes into this box during downtime, so we can keep track of all completed work that has not been entered into the computer.
Our laboratory minicomputer is not tied into the hospital mainframe for request and reporting purposes. If it were, we would notify the hospital information system by phone about any serious computer problem in the laboratory. We would also inform all nursing service units, by phone or hospital PA system, to let them know their CRTs could not call up lab results.
As things stand, we just have to notify all areas of the laboratory. They would be told whether the system is expected to be down less than six hours, in which case backup plan A takes effect, or for a longer period of time (backup plan B).
The main difference between the two plans is that, once the computer is operational again, all results are entered into it if downtime has lasted less than six hours. A lengthier downtime requires us to place manually prepared reports on patient charts. This is done every four hours by charting clerks. The original test request with results filled in is stamped "final copy, do not remove" and becomes part of the patient's hospital record. Two copies are made -- one placed in the laboratory data center downtime file for possible future reference, the other used for billing purposes.
Computerized results are normally conveyed via two ward summary reports a day, printed at about 10 a.m. and 5:30 p.m., and an early morning cumulative summary on each patient.
With downtime of six hours or less, the buildup of results is not so overwhelming that we cannot get them all into the computer when it is back up. Microbiology and urinalysis use mark sense cards. In those sections, it's just a matter of putting the cards into a reader. Other sections write the results on the test request forms and enter the requests and the results at the same time when the system is working again. All Stats and critical values are called to nursing service units.
Such batch work as chemistry screens and complete blood counts is done on analyzers that are interfaced to the laboratory computer, and results are automatically entered into the system. We therefore try to hold off on these tests until we determine whether the computer will be operational within six hours.
Every two hours during downtime, copies of a manual log of incoming test requests, organized by section, are distributed throughout the laboratory. Each section can then check if it has received all of its work or if work is still pending. As soon as the system is live again, before any data are entered or retrieved, we call up a collection summary. This is checked against our manual log to insure completion of all work and to avoid duplication.
Phlebotomy ordinarily uses our computer-printed tube labels as a drawing list. When the computer is down, it receives the original test requests. If any hamaatology work is ordered, we also give phlebotomy a special request form with spaces for CBC findings and other results, to be manually filled in as testing is performed. This form is taken to the nursing service unit, which stamps it with the patient's ID.
When a specimen is collected, it is sent along with the request to the laboratory section that will perform the tests. If several sections are involved, the request first goes to chemistry, which usually has the most work. Chemistry fills in its results on the request, then passes it on to the next section.
On early morning draws, all requests are organized by hospital area, and a log is written up. Copies go to the nursing service units and lab sections. By the way, a reliable copying machine is another key backup element.
We have had to use backup plan A several times since we installed the laboratory minicomputer nearly two years ago. Each time, the lab continued to run smoothly. Plan B was pressed into service only once, when we increased the computer's memory from 128K to 192K. The computer was down 15 hours, and even in all that time, there were no problems.
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|Publication:||Medical Laboratory Observer|
|Date:||Feb 1, 1985|
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