Outpatient order accuracy - A College of American Pathologists Q-Probes study of requisition order entry accuracy in 660 institutions

Context.--Laboratory test order entry errors potentially delay diagnosis, c onsume resources, and cause patient inconvenience. Objective.--To evaluate the frequency and causes of computer order entry er rors in outpatients. Design.--Cross-sectional survey and prospective sample of errors. Participa nts answered questions about their test order entry policies and practices. They then examined a sample of outpatient requisitions and compared inform ation on the requisition with information entered into the laboratory compu ter system. Order entry errors were divided into 4 types: tests ordered on the requisition, but not in the computer; tests performed but not ordered o n the requisition; physician name discrepancies; and test priority errors. Participants.--Six hundred sixty laboratories enrolled in the college of Am erican Pathologists Q-Probes program. Main Outcome Measure.--Overall order entry error rate. Results.--A total of 5514 (4.8%) of 114 934 outpatient requisitions were as sociated with at least 1 order entry error. The median participant reported 1 or more order errors on 6.0% of requisitions; 10% of institutions report ed errors with at least 18% of requisitions. Of the 4 specific error types, physician name discrepancies had the highest error rate, and test priority errors the lowest error rate. Four institutional factors were significantl y associated with higher overall error rates: orders verbally communicated to the laboratory; no policy requiring laboratory staff to compare a printo ut or display of ordered tests with the laboratory requisitions to confirm that orders had been entered correctly; failure to monitor the accuracy of outpatient order entry on a regular basis; and a higher percentage of occup ied beds (ie, a busier hospital). Conclusions.--Computer order entry errors are common, involving 5% of outpa tient requisitions. Laboratories may be able to decrease error rates by reg ularly monitoring the accuracy of order entry, substituting written and fac simile orders for verbal orders, and instituting a policy in which orders e ntered into computer systems are routinely rechecked against orders on requ isitions.