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Problems in Laboratory Testing in Primary Care
Paul A. Nutting, MD, MSPH;
Deborah S. Main, PhD;
Paul M. Fischer, MD;
Tina M. Stull, MD;
Mike Pontious, MD;
Milton Seifert, Jr, MD;
D. Joe Boone, PhD;
Sherry Holcomb
JAMA. 1996;275(8):635-639.
Abstract
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Objective.
—To examine the frequency and characteristics of problems in laboratory testing in primary care physicians' offices and their impact on health care.
Design.
—Prospective descriptive study in which participating office-based primary care clinicians reported each occurrence of any laboratory incident during a 6-month study. Each identified problem was reported on a structured data collection instrument with an open-ended description of the problem.
Setting.
—Primary care physicians' offices in North America.
Participants.
—One hundred twenty-four primary care clinicians in 49 practices of the Ambulatory Sentinel Practice Network (ASPN).
Main Results.
—A total of 180 problems were reported, yielding a crude rate of 1.1 problems per 1000 patient visits. Problems involving test ordering and specimen handling were the most common (56%), while those attributable to the test analysis itself accounted for 13% of the total. In the judgment of the practice staff, 27% of the reported problems had an impact on patient care. Of the 24 cases for which the specific impact was known and reported, half of the impacts were minor and about half were significant, as judged by whether or not the diagnosis and/or treatment of the patient was measurably affected.
Conclusions.
—Clinically apparent problems with laboratory testing in primary care were found at a rate of 1.1 problems per 1000 patient visits. Of the laboratory problems that occurred in this study, 27% were judged by the physician to have an effect on patient care.
(JAMA. 1996;275:635-639)
Author Affiliations
From the Ambulatory Sentinel Practice Network, Denver, Colo (Drs Nutting, Main, Pontious, and Seifert and Ms Holcomb); the Public Health Practice Program Office, Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Stull and Boone); the Department of Family Medicine, University of Colorado Health Sciences Center, Denver (Drs Nutting and Main and Ms Holcomb); and the Department of Family Medicine, University of Oklahoma at Enid (Dr Pontious). Drs Fischer and Seifert are in private practice in Augusta, Ga, and Excelsior, Minn, respectively.
Footnotes
Reprint requests to Ambulatory Sentinel Practice Network, 1650 Pierce St, Denver, CO 80214 (Dr Nutting).
Toward Optimal Laboratory Use section editor: George D. Lundberg, MD, Editor, JAMA.
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