Modification to use of pre-existing specimen lab list

In 2016, Yale New Haven Health went live with the Beaker laboratory information system from Epic. Beaker, by default, recommends that new orders for laboratory tests be done as an “add-on” to a pre-existing specimen when an appropriate specimen already exists in the lab at the time of order. This is designed to avoid subjecting the patient to another phlebotomy.

However, there are a number of tests that do not default, such as antibiotic and other drug levels. These default to a “new draw,” to better fit their most common clinical usage.

Recently, patient safety events have occurred as a result of a laboratory result value measured on a pre-existing specimen, when the ordering provider intended to order a new draw, rather than an add-on. As a result, the Medical Informatics Officers (MIOs) and Laboratory MIOs reviewed and proposed a number of additional tests to default to “new draw.”

The group is sensitive to the impact on patient experience, but feels the risk of defaulting to previous specimens outweighs that consideration for this additional group of studies.

As an ordering provider, if you are comfortable that a test that is being defaulted to “new draw” can be done on an existing specimen, simply change the default checkbox in the order. The presence of an acceptable specimen will continue to show in the order composer, but the default behavior will be to order a new draw.


Image of order collapsed


Image of order expanded with options to choose “New Collection” or “Use Existing Specimen”

If you are interested in reviewing the full list of default-new-draw tests, the list is available by following the "BEAKER Updates" link on the lower right of the Epic splash screen.