title: Preventing Genetic Testing Order Errors With a Laboratory Utilization Management Program.
abstract: OBJECTIVE
  To characterize error rates for genetic test orders between medical specialties and in different settings by examining detailed order information.
  
  
  METHODS
  We performed a retrospective analysis of a detailed utilization management case database, comprising 2.5 years of data and almost 1,400 genetic test orders. After review by multiple reviewers, we categorized order modifications and cancellations, quantified rates of positive results and order errors, and compared genetics with nongenetics providers and inpatient with outpatient orders.
  
  
  RESULTS
  High cost or problems with preauthorization were the most common reasons for modification and cancellation, respectively. The cancellation rate for nongenetics providers was three times the rate for geneticists, but abnormal result rates were similar between the two groups. The approval rate for inpatient orders was not significantly lower than outpatient orders, and abnormal result rates were similar for these two groups as well. Order error rates were approximately 8% among tests recommended by genetics providers in the inpatient setting, and tests ordered or recommended by nongeneticists had error rates near 5% in both inpatient and outpatient settings.
  
  
  CONCLUSIONS
  Clinicians without specialty training in genetics make genetic test order errors at a significantly higher rate than geneticists. A laboratory utilization management program prevents these order errors from becoming diagnostic errors and reaching the patient.
authors.affiliation: From the Department of Laboratory Medicine, University of Washington, Seattle;
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Mathias
authors.affiliation: Department of Laboratories, Seattle Children's Hospital, Seattle, WA.
authors.forename: Jessie H
authors.initials: JH
authors.lastname: Conta
authors.affiliation: From the Department of Laboratory Medicine, University of Washington, Seattle;
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Konnick
authors.affiliation: Department of Laboratories, Seattle Children's Hospital, Seattle, WA.
authors.forename: Darci L
authors.initials: DL
authors.lastname: Sternen
authors.affiliation: Department of Laboratories, Seattle Children's Hospital, Seattle, WA.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Stasi
authors.affiliation: Department of Laboratories, Seattle Children's Hospital, Seattle, WA.
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Cole
authors.affiliation: From the Department of Laboratory Medicine, University of Washington, Seattle; Department of Laboratories, Seattle Children's Hospital, Seattle, WA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Astion
authors.affiliation: From the Department of Laboratory Medicine, University of Washington, Seattle; Department of Laboratories, Seattle Children's Hospital, Seattle, WA. jane.dickerson@seattlechildrens.org.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Dickerson
mesh_terms: D005821:Genetic Techniques; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control*; D050316:Medical Order Entry Systems; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies
keywords: Genetic testing; Order errors; Utilization management