Laboratory medicine handoff gaps experienced by primary care practices: A report from the shared networks of collaborative ambulatory practices and partners (SNOCAP).
BACKGROUND
The majority of errors in laboratory medicine testing are thought to occur in the pre- and postanalytic testing phases, and a large proportion of these errors are secondary to failed handoffs. Because most laboratory tests originate in ambulatory primary care, understanding the gaps in handoff processes within and between laboratories and practices is imperative for patient safety. Therefore, the purpose of this study was to understand, based on information from primary care practice personnel, the perceived gaps in laboratory processes as a precursor to initiating process improvement activities.


METHODS
A survey was used to assess perceptions of clinicians, staff, and management personnel of gaps in handoffs between primary care practices and laboratories working in 21 Colorado primary care practices. Data were analyzed to determine statistically significant associations between categorical variables. In addition, qualitative analysis of responses to open-ended survey questions was conducted.


RESULTS
Primary care practices consistently reported challenges and a desire/need to improve their efforts to systematically track laboratory test status, confirm receipt of laboratory results, and report results to patients. Automated tracking systems existed in roughly 61% of practices, and all but one of those had electronic health record-based tracking systems in place. One fourth of these electronic health record-enabled practices expressed sufficient mistrust in these systems to warrant the concurrent operation of an article-based tracking system as backup. Practices also reported 12 different procedures used to notify patients of test results, varying by test result type.


CONCLUSIONS
The results highlight the lack of standardization and definition of roles in handoffs in primary care laboratory practices for test ordering, monitoring, and receiving and reporting test results. Results also identify high-priority gaps in processes and the perceptions by practice personnel that practice improvement in these areas is needed. Commonalities in these areas warrant the development and support of tools for use in primary care settings.
From the Department of Family Medicine, University of Colorado Denver, Aurora (DRW, KAJ, DHF, CZ); the Department of Laboratory Pathology, Mayo Clinic, Scottsdale, AZ (MLS); the Department of Pathology, University of Washington, Seattle (SSR); and the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (SSR). David.West@ucdenver.edu.
David R
DR
West
From the Department of Family Medicine, University of Colorado Denver, Aurora (DRW, KAJ, DHF, CZ); the Department of Laboratory Pathology, Mayo Clinic, Scottsdale, AZ (MLS); the Department of Pathology, University of Washington, Seattle (SSR); and the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (SSR).
Katherine A
KA
James
From the Department of Family Medicine, University of Colorado Denver, Aurora (DRW, KAJ, DHF, CZ); the Department of Laboratory Pathology, Mayo Clinic, Scottsdale, AZ (MLS); the Department of Pathology, University of Washington, Seattle (SSR); and the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (SSR).
Douglas H
DH
Fernald
From the Department of Family Medicine, University of Colorado Denver, Aurora (DRW, KAJ, DHF, CZ); the Department of Laboratory Pathology, Mayo Clinic, Scottsdale, AZ (MLS); the Department of Pathology, University of Washington, Seattle (SSR); and the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (SSR).
Claire
C
Zelie
From the Department of Family Medicine, University of Colorado Denver, Aurora (DRW, KAJ, DHF, CZ); the Department of Laboratory Pathology, Mayo Clinic, Scottsdale, AZ (MLS); the Department of Pathology, University of Washington, Seattle (SSR); and the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (SSR).
Maxwell L
ML
Smith
From the Department of Family Medicine, University of Colorado Denver, Aurora (DRW, KAJ, DHF, CZ); the Department of Laboratory Pathology, Mayo Clinic, Scottsdale, AZ (MLS); the Department of Pathology, University of Washington, Seattle (SSR); and the Department of Pathology, Memorial University/Eastern Health, St John's, Newfoundland, Canada (SSR).
Stephen S
SS
Raab
D000553:Ambulatory Care; D064790:Clinical Laboratory Services; D015331:Cohort Studies; D007753:Laboratories; D062209:Patient Handoff; D017010:Reminder Systems
Laboratories; Practice-based Research; Primary Health Care