title: A prospective tool for risk assessment of sendout testing.
abstract: OBJECTIVE
  Errors associated with laboratory testing can cause significant patient harm. Sendout testing refers to tests sent by a primary lab to a reference lab when testing is unavailable at the primary lab. Sendout testing is particularly high risk for patient harm, due to many factors including increased hand-offs, manual processes, and complexity associated with rare, low-volume tests. No published prospective tools exist for sendout risk assessment.
  
  
  METHODS
  A novel prospective tool was developed to assess risk of diagnostic errors involving laboratory sendout testing. This tool was successfully piloted at nine sites.
  
  
  RESULTS
  Marked diversity was noted among survey respondents, particularly in the sections on quality metrics and utilization management. Of note, most sites had committees who managed rules for test ordering, but few places reported enforcing these rules. Only one site claimed to routinely measure the frequency clinicians failed to retrieve test results. An evaluation of the tool indicated that it was both useful and easy to use.
  
  
  CONCLUSIONS
  This tool could be used by other laboratories to identify the areas of highest risk to patients, which in turn may guide them in focusing their quality improvement efforts and resources.
authors.affiliation: Department of Laboratories, Seattle Children's Hospital, Seattle, WA, United States; Department of Pathology, University of Washington, Seattle, WA, United States. Electronic address: bonnie.cole2@seattlechildrens.org.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Cole
authors.affiliation: Department of Laboratories, Seattle Children's Hospital, Seattle, WA, United States; Department of Lab Medicine, University of Washington, Seattle, WA, United States.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Dickerson
authors.affiliation: RTI International, Chapel Hill, NC, SUNY Stony Brook School of Medicine, NY, United States.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Graber
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, United States.
authors.forename: Corinne R
authors.initials: CR
authors.lastname: Fantz
authors.affiliation: Department of Pathology Microbiology and Immunology, Vanderbilt University, Nashville, TN, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Laposata
authors.affiliation: Agency for Healthcare Research and Quality, Rockville, MD, United States.
authors.forename: Kerm
authors.initials: K
authors.lastname: Henriksen
authors.affiliation: Department of Laboratories, Seattle Children's Hospital, Seattle, WA, United States; Department of Lab Medicine, University of Washington, Seattle, WA, United States.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Astion
authors.affiliation: Paul Epner LLC, Evanston, IL, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Epner
mesh_terms: D064790:Clinical Laboratory Services / Q000592:standards*; D019411:Clinical Laboratory Techniques / Q000592:standards*; D003625:Data Collection; D007753:Laboratories / Q000592:standards*; D019300:Medical Errors / Q000517:prevention & control*; D011785:Quality Assurance, Health Care / Q000379:methods*; D011786:Quality Control; D018570:Risk Assessment; D014481:United States
keywords: Errors; Laboratory risk; Reference laboratory; Referral laboratory; Risk assessment tool; Sendout