Toward optimal laboratory use. Problems in laboratory testing in primary care.
OBJECTIVE
To examine the frequency and characteristics of problems in laboratory testing in primary care physicians's offices and their impact on health care.


METHODS
Prospective descriptive study in which participating office-based primary care clinicians reported each occurrence of any laboratory incident during a 6-month study. Each identified problem was reported on a structured data collection instrument with an open-ended description of the problem.


METHODS
Primary care physicians' offices in North America.


METHODS
One hundred twenty-four primary care clinicians in 49 practices of the Ambulatory Sentinel Practice Network (ASPN).


RESULTS
A total of 180 problems were reported, yielding a crude rate of 1.1 problems per 1000 patient visits. Problems involving test ordering and specimen handling were the most common (56%), while those attributable to the test analysis itself accounted for 13% of the total. In the judgment of the practice staff, 27% of the reported problems had an impact on patient care. Of the 24 cases for which the specific impact was known and reported, half of the impacts were minor and about half were significant, as judged by whether or not the diagnosis and/or treatment of the patient was measurably affected.


CONCLUSIONS
Clinically apparent problems with laboratory testing in primary care were found at a rate of 1.1 problems per 1000 patient visits. Of the laboratory problems that occurred in this study, 27% were judged by the physician to have an effect on patient care.
Nutting
P A
PA
Ambulatory Sentinel Practice Network, Denver, CO 80214, USA.
Main
D S
DS
Fischer
P M
PM
Stull
T M
TM
Pontious
M
M
Seifert
M
M
Boone
D J
DJ
Holcomb
S
S
D019411:Clinical Laboratory Techniques / Q000592:standards* / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine / Q000592:standards / Q000706:statistics & numerical data; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D011787:Quality of Health Care; D013048:Specimen Handling; D014481:United States