Issues and Initiatives in the Testing Process in Primary Care Physician Offices

Hickner, John; Fernald, Douglas H.; Harris, Daniel M.; Poon, Eric G.; Elder, Nancy C.; Mold, James W.

doi:10.1016/s1553-7250(05)31012-9

Cited by 60 publications

(67 citation statements)

References 19 publications

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“…We elected to study testing process errors because tests are ordered during 39% of primary care outpatient encounters, 18 and testing errors are a serious safety threat to patients. 19 The testing process encompasses a series of decisions and actions that occur from the time a test is ordered to the time the appropriate follow-up action is taken with the patient. 19 Testing process errors account for 14% to 47% of reported errors in office practice.…”

Section: Error Reportingmentioning

confidence: 99%

“…19 The testing process encompasses a series of decisions and actions that occur from the time a test is ordered to the time the appropriate follow-up action is taken with the patient. 19 Testing process errors account for 14% to 47% of reported errors in office practice. 20 -22 At each of the 8 practices, physicians, nurse practitioners (NPs), physician assistants (PAs), office staff, and nurses submitted anonymous reports of errors observed in the course of clinical care related to the laboratory, radiology, and diagnostic testing processes.…”

Section: Error Reportingmentioning

confidence: 99%

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Barriers and Motivators for Making Error Reports from Family Medicine Offices: A Report from the American Academy of Family Physicians National Research Network (AAFP NRN)

Elder¹,

Graham²,

Brandt³

et al. 2007

The Journal of the American Board of Family Medicine

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Context:Reporting of medical errors is a widely recognized mechanism for initiating patient safety improvement, yet we know little about the feasibility of error reporting in physician offices, where the majority of medical care in the United States is rendered.Objective: To identify barriers and motivators for error reporting by family physicians and their office staff based on the experiences of those participating in a testing process error reporting study.Design: Qualitative focus group study, analyzed using the editing method. Setting: Eight volunteer practices of the American Academy of Family Physicians National Research Network.Participants: 139 physicians, nurse practitioners, physician assistants, nurses, and staff who took part in 18 focus groups.Instrument: Interview questions asked about making reports, what prevents more reports from being made, and decisions about when to make reports.Results: Four factors were seen as central to making error reports: the burden of effort to report, clarity regarding the information requested in an error report, the perceived benefit to the reporter, and properties of the error (eg, severity, responsibility). The most commonly mentioned barriers were related to the high burden of effort to report and lack of clarity regarding the requested information. The most commonly mentioned motivator was perceived benefit.Conclusion: Successful error reporting systems for physicians' offices will need to have low reporting burden, have great clarity regarding the information requested, provide direct benefit through feedback useful to reporters, and take into account error severity and personal responsibility.

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Section: Error Reportingmentioning

confidence: 99%

Section: Error Reportingmentioning

confidence: 99%

Barriers and Motivators for Making Error Reports from Family Medicine Offices: A Report from the American Academy of Family Physicians National Research Network (AAFP NRN)

Elder¹,

Graham²,

Brandt³

et al. 2007

The Journal of the American Board of Family Medicine

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“…These challenges are particularly acute for primary care physicians, who order the greatest variety of laboratory tests and order them during 30% to 40% of outpatient encounters. 1 Proposed solutions to improve the accuracy, efficiency, and safety of ordering clinical laboratory tests and interpreting the results include clinical decision support tools, trending of test results in electronic medical records (EMRs), 2 conditionspecific algorithms to help select tests, 3 professional practice guidelines, 4 and reflex laboratory testing. 5 Many electronic resources have been developed to aid diagnostic decision making.…”

mentioning

confidence: 99%

Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results

Hickner

Thompson

Wilkinson

et al. 2014

The Journal of the American Board of Family Medicine

128

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Background:The number and complexity of clinical laboratory tests is rapidly expanding, presenting primary care physicians with challenges in accurately, efficiently, and safely ordering and interpreting diagnostic tests. The objective of this study was to identify challenges primary care physicians face related to diagnostic laboratory testing and solutions they believe are helpful and available to them.Methods: In this study, sponsored by the Centers for Disease Control and Prevention, a random sample of general internal medicine and family medicine physicians from the American Medical Association Masterfile were surveyed in 2011.Results: 1768 physicians (5.6%) responded to the survey. Physicians reported ordering diagnostic laboratory tests for an average of 31.4% of patient encounters per week. They reported uncertainty about ordering tests in 14.7% and uncertainty in interpreting results in 8.3% of these diagnostic encounters. The most common problematic challenges in ordering tests were related to the cost to patients and insurance coverage restrictions. Other challenges included different names for the same test, tests not available except as part of a test panel, and different tests included in panels with the same names. The most common problematic challenges in interpreting and using test results were not receiving the results and confusing report formats. Respondents endorsed a variety of information technology and decision support solutions to improve test selection and results interpretation, but these solutions were not widely available at the time of the survey. Physicians infrequently sought assistance or consultation from laboratory professionals but valued these consultations when they occurred.Conclusions: Primary care physicians routinely experience uncertainty and challenges in ordering and interpreting diagnostic laboratory tests. With more than 500 million primary care patient visits per year, the level of uncertainty reported in this study potentially affects 23 million patients per year and raises significant concerns about the safe and efficient use of laboratory testing resources. Improvement in information technology and clinical decision support systems and quick access to laboratory consultations may reduce physicians' uncertainty and mitigate these challenges. (J Am Board Fam Med 2014;27:268-274.)

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“…[6][7][8] There are multiple steps involved in the management of test results. 1,9 These steps begin when offi ces track orders and the return of results to the physician's offi ce from the outside testing facility. If this step is not done automatically by means of an electronic health record (EHR), the results must then be given to the clinician who responds to the result.…”

mentioning

confidence: 99%

“…During this review, specifi c details about the management of each step in results management were collated, and factors of importance for test results management safety and quality for these offi ces were determined. To assist with thematic formation, existing recommendations from the literature 1,4,5,9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] about test results management were compared with the fi ndings from the offi ces. …”

mentioning

confidence: 99%

Management of Test Results in Family Medicine Offices

Elder

McEwen

Flach

et al. 2009

The Annals of Family Medicine

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PURPOSE We wanted to explore test results management systems in family medicine offi ces and to delineate the components of quality in results management.METHODS Using a multimethod protocol, we intensively studied 4 purposefully chosen family medicine offi ces using observations, interviews, and surveys. Data analysis consisted of iterative qualitative analysis, descriptive frequencies, and individual case studies, followed by a comparative case analysis. We assessed the quality of results management at each practice by both the presence of and adherence to systemwide practices for each results management step, as well as outcomes from chart reviews, patient surveys, and interview and observation notes. RESULTSWe found variability between offi ces in how they performed the tasks for each of the specifi c steps of results management. No offi ce consistently had or adhered to offi ce-wide results management practices, and only 2 offi ces had written protocols or procedures for any results management steps. Whereas most patients surveyed acknowledged receiving their test results (87% to 100%), a far smaller proportion of patient charts documented patient notifi cation (58% to 85%), clinician response to the result (47% to 84%), and follow-up for abnormal results (28% to 55%). We found 2 themes that emerged as factors of importance in assessing test results management quality: safety awareness-a leadership focus and communication that occurs around quality and safety, teamwork in the offi ce, and the presence of appropriate policies and procedures; and technological adoption-the presence of an electronic health record, digital connections between the offi ce and testing facilities, use of technology to facilitate patient communication, and the presence of forcing functions (built-in safeguards and requirements).CONCLUSION Understanding the components of safety awareness and technological adoption can assist family medicine offi ces in evaluating their own results management processes and help them design systems that can lead to higher quality care. Ann Fam Med 2009;7:343-351. doi:10.1370/afm.961. INTRODUCTIONP rimary care physicians order tests for a considerable number of patients. Recent estimates are that family physicians and general internists order laboratory tests in 29% and 38% of patient visits and imaging studies in 10% and 12%, respectively.1 These tests serve multiple purposes-some are for screening, others are diagnostic, and still others are used to manage and monitor medications and chronic health problems. Although some tests are performed in physicians' offi ces while patients wait, most are sent to reference laboratories, hospitals, and outside facilities.For more than a decade, research has documented that primary care physicians are concerned that their systems for managing test results are unsatisfactory. [2][3][4][5] In 3 primary care patient safety studies, 15% to 54% of O F FIC E M A NAG EMEN T O F T ES T R E SULT Sall errors reported by physicians were related to the testing proce...

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Issues and Initiatives in the Testing Process in Primary Care Physician Offices

Cited by 60 publications

References 19 publications

Barriers and Motivators for Making Error Reports from Family Medicine Offices: A Report from the American Academy of Family Physicians National Research Network (AAFP NRN)

Barriers and Motivators for Making Error Reports from Family Medicine Offices: A Report from the American Academy of Family Physicians National Research Network (AAFP NRN)

Primary Care Physicians' Challenges in Ordering Clinical Laboratory Tests and Interpreting Results

Management of Test Results in Family Medicine Offices

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