title: System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model.
abstract: OBJECTIVE
  To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards.
  
  
  METHODS
  A retrospective database analysis.
  
  
  METHODS
  General practices in the UK and Ireland.
  
  
  METHODS
  778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014.
  
  
  METHODS
  Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance.
  
  
  RESULTS
  CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the 'postanalytical test stage' (n=702, 43.8%), followed closely by 'communication outcomes issues' (n=628, 39.1%).
  
  
  CONCLUSIONS
  Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems.
authors.affiliation: Department of Medicine, NHS Education for Scotland, Glasgow, UK Institute of Health and Wellbeing, University of Glasgow, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Bowie
authors.affiliation: Medical Protection Society, Leeds, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Price
authors.affiliation: Medical Protection Society, Leeds, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Hepworth
authors.affiliation: Medical Protection Society, Leeds, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Dinwoodie
authors.affiliation: Department of Medicine, NHS Education for Scotland, Glasgow, UK.
authors.forename: John
authors.initials: J
authors.lastname: McKay
mesh_terms: D002984:Clinical Laboratory Information Systems; D003955:Diagnostic Tests, Routine; D005260:Female; D058006:General Practice / Q000458:organization & administration; D006801:Humans; D007494:Ireland; D008297:Male; D061214:Patient Safety; D011320:Primary Health Care / Q000458:organization & administration; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom
keywords: PRIMARY CARE