Sri Venkateshwara Multi-Speciality Hospital · Kukatpally, Hyderabad · 60 beds
PR
Laboratory
18 Jul 2026 · Prasad, Lab Technician · 5 orders incoming · 5 samples in pipeline
5
Orders awaiting collection
1
Urgent · STAT
2
Samples on analyser
1
Ready for validation
5
Reports published today
1
Critical · unacknowledged
Critical value unacknowledged for 35 minutes — Ravindra Reddy, T-11
Serum potassium 6.3 mmol/L against a high-critical limit of 6.0. Confirmed on a repeat
aliquot at 10:11 AM. Three escalation rungs have fired and no named clinician has answered. The report
is held from publishing until someone does.
Incoming test orders
Auto-refreshes from OPD & IPD ordersSwipe the table sideways for the ordering doctor and order time.
| Patient | Priority | Tests ordered | Ordering doctor | Ordered | |
|---|---|---|---|---|---|
Lakshmi Devi T-24 · 58F · T2DM · CKD 3a |
Routine | Urine Albumin (ACR), Serum Creatinine | Dr. K. Ramesh | 09:52 AM | |
Venkatesh Naidu T-25 · 44M · Hypertension |
Routine | Lipid Profile, KFT | Dr. K. Ramesh | 09:58 AM | |
Padma Sree T-26 · 28F · Pregnancy 24w |
Routine | Urine Routine, Hemoglobin | Dr. Sunitha Rao | 10:04 AM | |
B. Srinu T-27 · 67M · Post-op knee |
Urgent · STAT | CBC, CRP | Dr. P. Anil Kumar | 10:07 AM | |
Mohd. Irfan T-28 · 32M |
Routine | Widal Test, CBC | Dr. K. Ramesh | 10:11 AM |
Critical values today
2
1 acknowledged in 6 min · 1 open
Unacknowledged now
1
open 35 min · policy is 30
Median acknowledgement
6 min
rolling 30 days · n = 25
Inside the 30-min policy
92%
23 of 25 · 2 breaches, both logged
Open critical — Ravindra Reddy, 61M · T-11 · KFT + Serum Electrolytes
Escalation ladder, verification and contact log. The report cannot auto-publish while this is open.
Unacknowledged · 35 min
Serum potassium 6.3 mmol/L. The high-critical limit on this lab's list is 6.0 mmol/L
for an adult, set by Dr. Rajesh Varma, Lab Director and approved 02 Apr 2026. His previous
recorded potassium was 4.8 mmol/L on 12 May 2026 — a delta of +1.5, which is inside the
analyte's delta limit of 2.0, so no sample-identity query was raised. Ordering clinician:
Dr. K. Ramesh.
Verification before anyone was called
10:05Mindray BS-240Pro released the result over HL7 ORU^R01. Haemolysis index H 0 — the analyser reports no haemolysis, so the value is not a pre-analytical artefact.
10:06Auto-flagged against the critical list. A repeat run on a fresh aliquot was requested automatically before any escalation — a false critical that pages three people twice costs more trust than it saves.
10:11Repeat result 6.3 mmol/L. Value confirmed. Escalation started.
Escalation ladder
10:12Rung 1 — Dr. K. Ramesh (ordering clinician). Call placed, unanswered. WhatsApp and SMS sent with the value and the limit.
10:27Rung 2 — Dr. Sneha Reddy, duty RMO. Fired automatically at 15 minutes with no acknowledgement. Call placed, unanswered.
10:42Rung 3 — Dr. Rajesh Varma (Lab Director) and Sr. Mary Grace (Nursing Supervisor) paged. Fired at 30 minutes.
10:47Still unacknowledged, 35 minutes after the first contact. Nothing about this value has been published, and it stays on every section of this workspace until a named person answers.
Critical value log — last 30 days
25 events · every row carries who acknowledged it and how long they took
2 outside policy
Swipe the table sideways for the value, the limit and who acknowledged it.
| Released | Status | Patient | Analyte & value | Limit crossed | Acknowledged by | Elapsed |
|---|---|---|---|---|---|---|
| 18 Jul, 10:05 AM | Unacknowledged | Ravindra Reddy 61M · T-11 |
Potassium 6.3 mmol/L | > 6.0 (adult) | 3 rungs fired · nobody yet | 35 min |
| 18 Jul, 09:41 AM | Acknowledged | Mohd. Irfan 32M · T-05 |
Platelet count 46,000 /µL | < 50,000 (adult) | Dr. K. Ramesh · 09:47 AM · phone, value read back | 6 min |
| 17 Jul, 03:58 PM | Acknowledged | G. Satyanarayana 72M · T-31 |
Sodium 118 mmol/L | < 120 (adult) | Dr. K. Ramesh · 04:02 PM · phone, value read back | 4 min |
| 16 Jul, 11:12 AM | Acknowledged | Padma Sree 28F · antenatal 24w · T-14 |
Haemoglobin 7.6 g/dL | < 8.0 (antenatal) | Dr. Sunitha Rao · 11:21 AM · in person | 9 min |
| 15 Jul, 06:40 PM | Late — outside policy | B. Srinu 67M · post-op · T-27 |
Potassium 6.1 mmol/L | > 6.0 (adult) | Dr. P. Anil Kumar · 07:18 PM · phone, after 2 rungs | 38 min |
Note the antenatal row. Padma Sree's 7.6 g/dL crossed an antenatal critical limit of 8.0 — the
same value in a non-pregnant adult woman would have been flagged low but not critical. Population-aware
limits are the difference between an alert that gets answered and an alert nurses learn to mute.
The two late rows are shown, not filtered: a 92% figure with the failures hidden is not evidence.
Critical value list — approved by the lab director
Not vendor defaults. Every limit is signed by a named person on a dated version.
v4 · approved 02 Apr 2026
Swipe the table sideways for the population each limit applies to.
| Analyte | Low critical | High critical | Population | Escalate to |
|---|---|---|---|---|
| Potassium (K⁺) | < 2.8 | > 6.0 mmol/L | Adult | Ordering clinician → duty RMO → lab director |
| Sodium (Na⁺) | < 120 | > 160 mmol/L | Adult | Ordering clinician → duty RMO → lab director |
| Haemoglobin | < 7.0 | > 20.0 g/dL | Adult | Ordering clinician → duty RMO |
| Haemoglobin | < 8.0 | — | Antenatal | Ordering clinician → obstetric duty doctor |
| Platelet count | < 50,000 | > 10,00,000 /µL | Adult | Ordering clinician → duty RMO |
| Glucose (random) | < 45 | > 500 mg/dL | Adult | Ordering clinician → duty RMO |
| Glucose (random) | < 40 | > 300 mg/dL | Neonate | Paediatrician on call, immediately |
Policy: acknowledgement within 30 minutes; rung 2 fires at 15 minutes, rung 3 at 30.
The list, the ladder and the 30-day compliance number export as one PDF for the NABH file —
which is the actual deliverable, because an assessor asks for the evidence, not the feature.
Sample tracking board
Custody chain from collection to validationSample pending2
Fathima Begum
CBC, ESR
Awaiting phlebotomy
Ramesh Babu
LFT, Serum Amylase
Awaiting phlebotomy
Processing2
Lakshmi Devi
HbA1c, CBC, Fasting Glucose
On analyser · Prasad
Vijaya Lakshmi
Urine Routine, Hemoglobin
On analyser · Prasad
Ready for validation1
Ravindra Reddy
KFT, Serum Electrolytes
Critical K⁺ 6.3 — held from publishing
Hover preview · his last panel
12 May 2026 — Creatinine 1.4 mg/dL, K⁺ 4.8 mmol/L. Today's potassium is +1.5 against that value.
Sign-off is blocked on the Ready-for-validation card, not hidden. A sample carrying an unacknowledged critical
value cannot be moved to publishing by dragging a card — the block is on the acknowledgement, and the
only way past it is a named clinician answering. Everything else on this board moves freely.
Connected analysers
Bi-directional means the analyser also receives the worklist, so nobody types a patient ID into a machine
4 of 5 links bi-directional
Swipe the table sideways for tests mapped and last message time.
| Analyser | Status | Protocol | Direction | Tests mapped | Last message |
|---|---|---|---|---|---|
| Haematology Sysmex XN-330 |
Online | ASTM E1394 | Bi-directional | CBC — 24 parameters, LOINC-mapped | 10:44 AM |
| Biochemistry Mindray BS-240Pro |
Online | HL7 v2.5.1 ORU^R01 | Bi-directional | 42 assays — KFT, LFT, Lipid, Electrolytes | 10:41 AM |
| Urine analyser Erba Laura Smart |
Online | ASTM E1394 | Bi-directional | Urine routine — 11 parameters | 10:38 AM |
| Referral partner Vijaya Diagnostics — outsourced assays |
Online | HL7 over partner API | Bi-directional | CRP, Widal, Vitamin D, Thyroid profile | 09:22 AM |
| HbA1c Bio-Rad D-10 |
Online · results only | ASTM, uni-directional | Results in, no worklist out | HbA1c only | 10:12 AM |
The honest row is the last one. The Bio-Rad D-10 sends results but accepts no worklist, so its
sample IDs are still keyed in by hand — one transcription point remains in this lab, and it is on
the HbA1c bench. Saying "fully interfaced" while that is true would be the kind of claim that survives a
demo and fails an audit.
✦
Order → barcode → analyser → record, with nobody retyping anything
Productivity tier · transcription, not interpretation
01 · 09:05 AM
Order placed
Dr. K. Ramesh, OPD. FHIR ServiceRequest SR-2026-11842 — HbA1c, CBC, Fasting Glucose.
02 · 09:39 AM
Barcode printed
Accession LAB2607180312 on a thermal label at the phlebotomy station. The tube is the identity from here on.
03 · 09:42 AM
Tube scanned
Sysmex XN-330 pulled the worklist for that accession over ASTM. No patient name was typed into the analyser.
04 · 10:03 AM
Results returned
24 CBC parameters back over ASTM, mapped to LOINC and written as FHIR Observation resources.
05 · pending
Human validation
Nothing publishes until Prasad validates. The machine fills the form; a person signs it.
Raw ASTM E1394 frame received from the Sysmex XN-330 at 10:03 AM — accession LAB2607180312:
1H|\^&|||XN-330^1|||||||P|E1394-97|20260718100301
2P|1||MRN0031180||DEVI^LAKSHMI||19680204|F
3O|1|LAB2607180312||^^^CBC^Complete Blood Count|R||20260718094212|||||||||||||||||F
4R|1|^^^718-7^Hemoglobin|11.2|g/dL|12.0 to 15.0|L||F||PRASAD|20260718100255
5R|2|^^^6690-2^Leukocytes|7800|/uL|4000 to 11000|N||F||PRASAD|20260718100255
6R|3|^^^777-3^Platelets|240000|/uL|150000 to 410000|N||F||PRASAD|20260718100255
7L|1|N
Note the L flag on line 4 and the reference interval the analyser itself sent. HOS stores the
analyser's flag alongside its own range comparison — if the two ever disagree, that is a calibration
question, and you want the evidence rather than a single reconciled number.
The error this removes
From this lab's own amendment register — not a vendor statistic
14 Feb 2026, before the Mindray link went live. A serum potassium of 5.2 mmol/L was
keyed onto a manual worksheet as 2.5. Two digits transposed — and the two readings sit at
opposite ends of the reference range, so the error looked like a finding rather than a typo.
Caught on the ward round; the report was amended 4 hours after publication.
Manual entry has three transcription points per result — analyser screen → paper worksheet →
LIS keyboard. An interfaced analyser has none.
Amendment register, this lab: 9 of 1,240 manually keyed results were corrected after
publication in Jan–Mar 2026 — 0.73%. Since the Sysmex and Mindray links went live in April,
0 of 3,180. The one remaining manual bench is HbA1c.
What interfacing does to TAT
The same 3 stages, measured before and after April
Accession → analyser start
3 min
Analyser run
21 min
Result into the record
4 min
Before April the last stage averaged 17 minutes — worksheet, walk, keyboard, double-check.
It is now 4, and the 4 is a person reading the screen before validating, which we are not
trying to remove. 13 minutes came off every single result in this lab, which is where a
third of the total TAT improvement came from.
Lakshmi Devi
·
58F · T2DM · Token T-08
·
Ordered by Dr. K. Ramesh
On analyser · Prasad
Swipe the table sideways for the reference range and the change since 21 Jun.
| Investigation | Result value | Flag | Unit | Reference range applied | Her previous · delta |
|---|---|---|---|---|---|
| HbA1c | High | % | Non-diabetic 4.0–5.6% · her recorded target <7.0% (T2DM, 2022) | 8.1% · 21 Jun +0.3 | |
| Fasting glucose | High | mg/dL | 70–100 mg/dL (fasting, adult) | 154 · 21 Jun +14 | |
| Hemoglobin (Hb) | Low | g/dL | 12.0–15.0 g/dL (female, 18–65 y, not pregnant) | 11.6 · 21 Jun −0.4 | |
| WBC count | Normal | /µL | 4,000–11,000 /µL (adult) | 8,100 · 21 Jun −300 | |
| Platelet count | Normal | lakh/µL | 1.50–4.10 lakh/µL (adult) | 2.60 · 21 Jun −0.20 |
Which range was applied, and why
Haemoglobin
12.0–15.0 g/dL — female, 18–65 years, not pregnant. The same analyte would use
13.0–17.0 for an adult male and 11.0–14.0 with a critical low of 8.0 for an
antenatal patient. That antenatal limit is what flagged Padma Sree's 7.6 g/dL on 16 Jul as
critical rather than merely low.
Platelet count
1.50–4.10 lakh/µL — adult, sex-independent. Neonatal and paediatric intervals differ
and are held separately in the range table.
HbA1c target
<7.0% — and this one is not a reference range at all. It comes from the T2DM
entry on her problem list, recorded 2022. HOS shows both: the population range (4.0–5.6%) and the
target already written into her record. It does not invent a target for her.
Ranges are held per analyte × sex × age band × state (pregnancy, neonate), versioned, and stamped with who approved them — the same discipline as the critical value list.
Delta check against her own last result
A delta limit is the largest change between two draws that is explainable. Exceeding it raises a
sample-identity query, not a clinical one — the usual cause is a mislabelled tube, and
catching that is worth more than any interpretation.
| Analyte | Status | Delta | Delta limit |
|---|---|---|---|
| HbA1c | Within | +0.3 | 1.5 |
| Fasting glucose | Within | +14 | 90 |
| Haemoglobin | Within | −0.4 | 2.0 |
| Platelets | Within | −0.20 | 1.20 |
All four are within limit, so no query is raised. On 12 Jun a potassium delta of +2.9 on a
different patient exceeded its limit of 2.0; the redraw came back normal and the first tube turned
out to be mislabelled. That is the entire value of this check, and it happens twice a quarter.
✦
AI interpretation draft
Draft — awaiting approval
HbA1c 8.4% is above the <7.0% target recorded on this patient's problem list (T2DM, 2022). Her previous value was 8.1% on 21 Jun (+0.3). Fasting glucose 168 mg/dL is above the 70–100 mg/dL fasting reference range; her previous was 154 on 21 Jun (+14). Hb 11.2 g/dL is below the 12.0–15.0 g/dL range applied for a non-pregnant female aged 18–65; her last four values were 12.8, 12.1, 11.6 and now 11.2. WBC 7,800/µL and platelets 2.40 lakh/µL are within reference range. No value exceeds its delta limit, so no sample-identity query is raised. Interpretation and next steps are yours — this is a comparison against reference ranges and her own recorded history, nothing more.
Source: reference-range engine (v4, per analyte × sex × age band) + Dr. K. Ramesh's problem list (T2DM, dtd. 2022) + her own results of 21 Jun 2026
Validating locks the values and sends to Reports & Delivery for publishing.
Average TAT today
1h 42m
18 min faster than last week's 2h 00m
Routine · rolling 30 days
2h 05m
order to published, n = 486
STAT · rolling 30 days
38m
median, n = 112
Today's open STAT
40m
B. Srinu, T-27 — clock still running
Where today's 1h 42m actually goes
Five stages, averaged over the 5 reports published today. They sum to 102 minutes.
Stage 1 is 40% of the total
Order → sample collected
41 min
Collected → received in lab
7 min
Accession → analyser result
28 min
Result → validated
19 min
Validated → published & delivered
7 min
41 + 7 + 28 + 19 + 7 = 102 minutes = 1h 42m. The analyser run is the stage everyone assumes is
the problem and it is the one stage nobody can compress — a CBC takes what it takes.
The queue in front of the needle is 40% of the total, and it is free to fix.
Order → collection, by hour of the day
The same stage, split by when the order was placed. Day average 41 min.
10–11 AM: 74 min
Swipe the chart sideways for the 11 AM and 12 PM hours.
22
7 AM
26
8 AM
38
9 AM
74
10 AM
49
11 AM
31
12 PM
Two phlebotomists cover 08:00–16:00. OPD order volume peaks between 09:30 and 11:00 at 3.4 orders
every 10 minutes, which is more than two draw stations absorb — so the queue builds at 10 and is
still draining at 11. Nothing about the lab is slow in that hour; the arrival rate is.
✦
Rostering change — 2-hour overlap, not a new post
Draft — awaiting approval
The 10 AM hour carries 31% of the day's orders. Moving one phlebotomist's shift to create a
09:30–11:30 overlap — the same two people, one starting later — takes stage 1 in that hour from
74 minutes to about 38, the figure the 9 AM and 11 AM hours already achieve at similar volume.
Weighted across the day that pulls the average from 102 minutes to 91 (1h 31m): 102 − (0.31 × 36).
No new headcount, no new equipment.
Source: 30 days of accession timestamps · OPD order arrival curve · the current phlebotomy roster in Administration → Staff & Roles
What this section does not do: it never reorders the queue by how sick anyone is. Assigning
clinical acuity is a regulated decision — Administration → AI Quality lists acuity-assigning triage as
not enabled. Every STAT flag in this workspace was set by the doctor who placed the order.
HOS measures the queue and staffs it; it does not decide who deserves to be in front.
Published today — 5 reports
TAT is order-to-published for each one. They average 102 min, which is the 1h 42m on the hero.
Swipe the table sideways for TAT and the PDF button.
| Patient | Test panel | Ordering doctor | Ordered | Published | TAT | |
|---|---|---|---|---|---|---|
Mohd. Irfan 32M · Token T-05 |
Dengue NS1 Antigen, Platelet Count | Dr. K. Ramesh | 08:45 AM | 10:18 AM | 93 min | |
B. Srinu 67M · Token T-07 |
Haemoglobin, PT/INR (post-op day 3) | Dr. P. Anil Kumar | 08:16 AM | 09:52 AM | 96 min | |
Venkatesh Naidu 44M · Token T-02 |
Fasting Glucose, HbA1c | Dr. K. Ramesh | 07:34 AM | 09:20 AM | 106 min | |
Fathima Begum 34F · Token T-04 |
Thyroid Profile (TSH, FT4) | Dr. Sunitha Rao | 07:20 AM | 09:11 AM | 111 min | |
Ravindra Reddy 61M · Token T-01 |
CBC, ESR | Dr. K. Ramesh | 07:02 AM | 08:46 AM | 104 min |
93 + 96 + 106 + 111 + 104 = 510 minutes over 5 reports = 102 min = 1h 42m, the figure on the
hero. Ravindra Reddy's KFT is not on this list and will not be until the critical potassium
is acknowledged — a held report is the one thing in a lab that must never quietly publish itself.
Delivery status
Read receipts pulled from WhatsApp Business API| Patient | Test panel | Sent | Channel | Status |
|---|---|---|---|---|
| Mohd. Irfan | Dengue NS1, Platelets | 18 Jul 2026, 10:20 AM | SMS (WhatsApp opt-out) | Sent |
| B. Srinu | Haemoglobin, PT/INR | 18 Jul 2026, 09:54 AM | Read | |
| Venkatesh Naidu | Fasting Glucose, HbA1c | 18 Jul 2026, 09:22 AM | Read | |
| Fathima Begum | Thyroid Profile | 18 Jul 2026, 09:13 AM | Delivered | |
| Ravindra Reddy | CBC, ESR | 18 Jul 2026, 08:48 AM | Read |
5 sent · 3 of the 4 WhatsApp deliveries have been read; Mohd. Irfan opted out of WhatsApp so
his went by SMS, where there is no read receipt to have. A delivery dashboard that counted an SMS as
"unread" would be measuring the channel, not the patient.
✦
Telugu patient summary
Draft — awaiting approval
Drafted for Lakshmi Devi the moment her HbA1c/CBC/FBS values came off the analyser — plain-language bilingual summary, no raw values that could alarm without context. Nothing sends until her results are validated in Result Entry.
LD Lakshmi Devi · +91 98480 1123•
Not sent yet — tap ✦ Approve & send to compose and deliver this summary.