title: Test result communication in primary care: a survey of current practice.
abstract: BACKGROUND
  The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities.
  
  
  METHODS
  We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure.
  
  
  RESULTS
  Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results.
  
  
  CONCLUSIONS
  The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the handling of samples and the reporting of results. Our findings will inform our continuing work with patients and staff to develop, implement and evaluate improvements to existing systems of managing the testing and result communication process.
authors.affiliation: School of Health and Population Sciences, Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Litchfield
authors.affiliation: School of Health and Population Sciences, Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Bentham
authors.affiliation: Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Lilford
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
authors.affiliation: Department of Transformation, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Hill
authors.affiliation: School of Health and Population Sciences, Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Greenfield
mesh_terms: D001291:Attitude of Health Personnel; D003955:Diagnostic Tests, Routine; D004739:England; D058006:General Practice; D019538:Health Care Surveys; D006282:Health Personnel / Q000523:psychology*; D006403:Hematologic Tests; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007755:Laboratories, Hospital; D010361:Patients; D010820:Physicians; D011369:Professional-Patient Relations; D013222:State Medicine
keywords: Communication; Primary care; Process mapping; Quality improvement; Surveys