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Using Lotus 1-2-3 to assist with indicator monitors.

A SPREADSHEET PROGRAM is a computer program that organizes information on a computer monitor in rows and columns. It can act as a calculator, obeying commands in the form of formulas, and allows you to erase or type over entries electronically. This type of program is ideally suited to assist laboratorians with the organization and analysis of information obtained from indicator monitors.

Indicators are objective variables representing areas of the lab that affect the length and quality of life provided for patients.|1,6~ Indicators are monitored by comparing them with target thresholds.|1~ If monitoring indicates that performance meets the threshold, no further study is needed. A useful indicator, however, is one that is monitored repeatedly and that triggers improvement in performance if it falls below the laboratory's standard.|1~

* The essential link. Since the checklist of the College of American Pathologists (CAP) now holds the lab responsible for accurate transcription of doctors' orders onto requisition slips,|2~ this process will be used as an indicator to illustrate how a Lotus 1-2-3 (Release 3.1, Lotus Development Corp., Cambridge, Mass.) database table can be used to assist with monitor analysis.|1~

The laboratory requisition is an essential link between the ordering location and the laboratory.|3~ Of particular importance is the recording of the doctor's name, which facilitates result reporting, and the date and time of specimen collection, which allows for the determination of transport time, a critical factor in the evaluation of microbiologic culture and specimen degradation.|3~

* Designing data collection forms. Raw data is collected on a form designed specifically for the monitor. The date and shift of data collection are part of the heading. This is followed by explicit instructions that insure uniformity in the format of data recording. Accession number and patient location are recorded in the event that a review of the data becomes necessary. A "1" or a "0" is used to indicate the presence or absence of a physician's name and the date and time of specimen collection. This system of scoring lends itself to computer analysis since computers can recognize and manipulate numeric values easily.

* Designing a database table. When preparing a database table, the format of the data collection form should be preserved. The first row of the database table must have unique field names and subsequent rows must contain records. The table must not contain any blank rows or dividers, and the entries in each field should be consistent in type: either all labels or all values.|4~

To manage a database table, an input range, criteria range, and output range must be specified. The input range is established through the /Data Query Input menu path. This range should include the database table field names and the records in the database table to be searched.

The criteria range is established through the /Data Query Criteria menu path and contains the selection criteria by which records in the database table are to be searched. The criteria range must consist of at least two rows. The first row must include one or more field names from the database table. The second and third rows must contain the parameters for the selection of information. Criteria parameters for different fields in a single row are treated as an "AND" condition for a search. Criteria parameters entered in separate rows are treated as an "OR" condition.

The output range is set up through the /Data Query Output menu path and specifies the range in which results from extracted records will be placed.|4~

After the input, criteria, and output ranges have been established, the /Data Query Extract menu path is used to copy to the output range the information from the input range that matches the selection parameters of the criteria range.

Setting up an input, criteria, or output range erases the settings of a previously set range of the same type. In Figure 1, the input range remains the same and includes all the records entered into the database table. The criteria ranges, output ranges, and subsequent calculations are arranged in tabular format. Each criteria range is used in conjunction with an output range and calculation located in the same row of the table. Each criteria range begins with the field names being searched. The values beneath the field names represent the criteria for the selection of records. Information for all records matching the specified pattern of zeros and ones are extracted to the output range. The output range employs an aggregate column that uses a formula function that calculates a total for a group of related values.|5~ The numeric value entered in the "RVAL" record field is tallied and represents the total number of records matching the selection criteria. Each criteria and output range pair employed must be individually set up, and information must be extracted from the input before proceeding to the next criteria and output range pair. This procedure is repeated until the table is complete. The totals placed in the output range are processed by the formulas listed in the calculation table. To check accuracy, the sum of the percentages of all the combinations of "NAME," "DATE," and "TIME" searched must equal 100%.

The calculated values and the totals of the output ranges can be presented as part of a report. The report can be arranged as a table employing a long label to help define a calculated result. The footnote regarding the total number of requisitions entered in cell U32 is an example of a long label. A long label is a label longer than its cell column width. When using a long label, the cells immediately to the right of the label must be blank so that the portion of the label that overlaps neighboring cells can be displayed. Once the label is entered, the blank cell to the right of the label is used to display the corresponding result. Results are entered by using the "+" symbol and the cell reference.|4~

* Summary. Spreadsheet database tables provide accuracy and flexibility for analysis of indicator monitors and afford substantial time savings. The ease of data rearrangement allows for better detection of patterns, more accurate comparisons against accepted threshold values, and enhances the laboratorian's ability to make recommendations.


1. Baer DM, Belsey RE, Schaefer B. How to earn perfect scores from your JCAHO surveyor. MLO. 1991; 23(12): 37-40.

2. Bartlett RC. Quality assurance in the clinical microbiology laboratory. In: Balows A, Hausler WJ Jr., Herrmann KL, Isenberg HD, and Shadomy HJ, eds. Manual of Clinical Microbiology. 5th ed. Washington, DC: American Society for Microbiology; 1991: 36-43.

3. Chou D, Connelly DP, Fine JS. Quality assurance and laboratory information flow. In: Howanitz PJ, Howanitz JH, eds. Laboratory Quality Assurance. New York, NY: McGraw-Hill; 1987: 354-370.

4. Lotus 1-2-3 Release 3.1 Reference manual. Cambridge, Mass: Lotus Development Corp.; 1990.

5. Lotus 1-2-3 Release 3.1 Tutorial. Cambridge, Mass: Lotus Development Corp.; 1990.

6. Murdock S, Trujillo JM. Evolving concepts of quality in laboratory medicine. Clin Lab Sci. 1992; 5(2): 90-93.

The author is assistant attending microbiologist in the division of microbiology, department of pathology, Queens Hospital Center, Jamaica, N.Y.
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Title Annotation:Computer Dialog
Author:Dalto, Michael
Publication:Medical Laboratory Observer
Date:Aug 1, 1993
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