Physician performance of laboratory tests in self-service facilities. Residents' perceptions and performance
L. H. Hilborne, N. S. Wenger and R. K. Oye
Department of Pathology, University of California, Los Angeles School of Medicine 90024-1732.
Primary care physicians perform simple laboratory tests in clinical
practice, frequently with little formal training. To determine the
frequency of tests that are performed and evaluate house officer laboratory
skills, we surveyed house officer attitudes and tested their ability to
perform four common laboratory tests. We received 193 responses from 254
house officers at one university teaching hospital. While most perceived
the need to use ward laboratories (ie, self-service laboratories located on
patient care wards), 67% used them infrequently. Barriers included poor
laboratory condition, inadequate time, accuracy, and infectious exposure
concerns. Twenty-four percent felt they did not know or were unsure if they
knew how to perform simple tests. Forty-seven house officers completed the
practical examination. Most accurately reported a spun hematocrit and
correctly identified white blood cell findings on a blood smear. Only 50%
counted 100 cells. Urinary dipstick interpretation was generally acceptable
but the microscopic examination was less accurate. Twenty-three percent
failed to identify gram-negative rods on a slide with both gram-positive
cocci and gram-negative rods. If physicians are to perform selected
laboratory tests, these data suggest, at least in one institution, more
formal training, practice, and evaluation are necessary to ensure their
performance with adequate proficiency.
