PROBLEMS IN LABORATORY TESTING IN PRIMARY-CARE

Objective. - To examine the frequency and characteristics of problems in laboratory testing in primary care physicians' offices and their im pact on health care. Design. - Prospective descriptive study in which participating office-based primary care clinicians reported each occur rence of any laboratory incident during a 6-month study. Each identifi ed problem was reported on a structured data collection instrument wit h an open-ended description of the problem. Setting. - Primary care ph ysicians' offices in North America. Participants. - One hundred twenty -four primary care clinicians in 49 practices of the Ambulatory Sentin el Practice Network (ASPN). Main Results. - A total of 180 problems we re reported, yielding a crude rate of 1.1 problems per 1000 patient vi sits. Problems involving test ordering and specimen handling were the most common (56%), while those attributable to the test analysis itsel f accounted for 13% of the total. In the judgment of the practice staf f, 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 measu rably affected. Conclusions. - Clinically apparent problems with labor atory 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.