Tracers: What to Expect

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The page below is a sample from the LabCE course Inspection Preparation, Process, and Corrective Action. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Tracers: What to Expect

As part of the inspection process, the laboratory may wish to perform mock tracers. Tracers may be an integral part of the inspection process, depending on the inspection agency and the inspector(s).
Tracers are used to assess any aspect of a system or process. The basic premise of a tracer is to follow a work process from inception to completion. For example, if a complete blood count is being assessed, the process will begin with the sample collection and end with an appropriate order in the electronic medical record (EMR).
Inspectors may choose to conduct one or more tracer studies as a part of the inspection process. A tracer specimen in the lab assesses the lab's processes rather than patient care. However, other agencies, such as The Joint Commission, focus on patient care processes.
A laboratory tracer is designed to evaluate process performance, with the primary focus being the integration of related processes within the laboratory testing process. As with a tracer focused on direct patient care, the laboratory tracer examines interrelationships in the testing process.

The goal of the trace is to identify strengths and weaknesses in the overall work process being evaluated. In particular, the identification of specific concerns when tracing the relevant processes is noted and corrected if found to be inappropriate or not comprehensive.
A laboratory tracer typically begins with preanalytical handling, i.e., the collection of the sample, and then progresses from preanalytic through post-analytic processes. The inspector will "follow" this testing process through all laboratory departments and areas that were involved in the entire test process.
The Joint Commission provides some tips1 for consideration when conducting a laboratory tracer:
  1. Focus on concerning issues for laboratory operations and process interfaces with clinical staff -- Some examples of concerning issues include patient identification, quality control, communication, etc.
  2. Possibly use the laboratory's past testing activity as a starting point -- some focus points may be test methods with previous QC issues or out-of-range proficiency testing.
  3. Select a patient who has received multiple laboratory tests, possibly including some point of care testing -- this allows for examination of multiple processes within the laboratory.
  4. Work as a group, rather than a single individual, for additional insight and problem-solving process -- helps to enhance staff understanding of tracers and group thought processes for the resolution of negative outcomes.
  5. Do not just consider the outcome. Consider the entire process from beginning to end. Look for gaps or missteps -- to be discussed and recognition of multiple paths with pitfalls that may have led to the same negative outcome.
1. The Joint Commission: The Source. Tracer Methodology 101: The Laboratory Tracer. The Joint Commission on Accreditation Organizations. September 2010. Volume 8, Issue 9, p. 2