Primary care physicians order a lot of tests – to diagnose complaints, to monitor chronic diseases, to check medication levels, to screen for health risks and early disease. A survey of over 1700 physicians in 2013 suggested that 31.4% of encounters resulted in a laboratory order. The same survey suggested that 15% of the time, the physician was uncertain as to what to order. On receiving results, nearly 10% of results were difficult to interpret. 6% of all office visits have a missing laboratory. Studies have found that up to 54% of errors in the primary care office are related to the testing process.
This process model suggests that laboratory test errors can result from:
- Uncertainty about which test to order
- Performance of the test in the lab
- Tracking of results in the office
- Timely and appropriate response to test results
What are strategies in office practice that can minimize test result errors, and protect your patient from failures in the system? Dr. Nancy Elder, a family physician who has conducted extensive research in office based patient safety, has promoted a set of organization safety measures for better managing test results in office practice.
- Identify specific staff members to manage the receipt and filing/processing of laboratory results
- Develop relationships with your clinical pathologist. Consult them for any ordering question.
- Develop protocol for results management including ordering process, review by whom and by when, tracking and monitoring results, and communication of results to patients
- Specific protocols written for laboratory test ordering, and design into order sets for your HER
- Standardize correspondence with patients– what requires phone call, what is written.
NEXT BLOG: infection prevention in office settings.