Set Up a Multi-Step Result-Approval Chain
Who / when: the lab manager sets this up once per test area; the lab scientists and senior reviewers then follow it on every result. Some results — and some labs — need more than one pair of eyes before a value is released. A multi-step approval chain lets a manager say, for a given department, “a result here is only released after a senior reviews it, and then a manager signs it off.” Each step is an electronic signature by a different person, so no single individual can both enter and release a result. When a department has no chain, results follow the ordinary single (or two-stage) sign-out — nothing changes unless you turn a chain on.
This is the control that lets you tell a patient, an auditor or an accreditor: every result was checked by more than one qualified person before it left the lab, and we can show you exactly who, and when.
We’ll follow Adunni, the lab manager, who sets up a two-step chain for Chemistry; then Chika, a scientist, and Dr. Okafor, the senior who reviews her work.
Part A — Build the chain (lab manager, once)
Section titled “Part A — Build the chain (lab manager, once)”- Lab Manager — open Labs → Settings. Scroll to the “Result-Approval Chains” card. At the top right, pick the test area the chain governs (for example Chemistry). Each area has its own chain, so you can be strict where it matters and light where it doesn’t.
- Lab Manager — press ”+ Add Step” to add the first approval step. Give it a clear name — for example “Senior Review” — then choose who may sign it:
- Any holder of a role — anyone with the chosen role (e.g. Lab Manager / Admin, Lab Scientist, Pathologist) can sign this step. Use this when any senior on shift should be able to review.
- Named people — only the specific staff you add can sign this step. Search for each person and add them. Use this when a particular reviewer must sign (for example a single pathologist for histology).
- Lab Manager — press ”+ Add Step” again to add a second step — for example “Manager Release”, set to the Lab Manager / Admin role. You can have up to three steps. The result is released only after the last step is signed.
- Lab Manager — turn “Chain Active” on, then press “Save Chain”. From now on every Chemistry result follows these two steps before it can be released. (To stop using it later, open the same card and press “Remove Chain” — Chemistry reverts to the ordinary sign-out with nothing lost.)
Part B — Walk the chain on a result (the bench)
Section titled “Part B — Walk the chain on a result (the bench)”- Lab Scientist (Chika) — process and enter the Chemistry result as normal in Labs → Results & Worklist. When the values are in, the panel shows an “Approval chain — step 1 of 2” banner with every step laid out, and the action button reads “Approve: Senior Review” instead of the usual “Verify & Sign Out”. Press it and enter your 6-digit eSign PIN. Your signature is recorded against step 1 — but the result is not released yet.
- Senior Reviewer (Dr. Okafor) — the same result now shows step 1 ticked with Chika’s name and step 2 (“Manager Release”) awaiting. Open it, check the values, and press “Release (Final Approval)”. Enter your eSign PIN, confirm, and the result moves to Released — now it reaches the ordering clinician and the patient.
What happens next
Section titled “What happens next”Once the final step is signed, the result behaves exactly like any released result: the ordering physician is notified, the value appears on the chart and is eligible for the patient portal, the branded PDF is generated, and any critical value starts its read-back loop. Until that final step, the result stays in review and never reaches the patient. Every signature — who signed which step, and at what time — is kept on the result’s record and in the tamper-evident audit log.
Why this matters for patients and stakeholders
Section titled “Why this matters for patients and stakeholders”A result that passes through an approval chain carries proof that it was reviewed and signed by more than one qualified person before release. That trail is permanent and tamper-evident, which is exactly what quality programmes and accreditation bodies look for. If a patient, a clinician or an auditor ever asks “who checked this result?”, the answer is on the record: the reviewer, the releaser, and the moment each signed. Patients see plain assurance on the portal that their results are reviewed before release; see View Your Results on the Portal.