Management of Test Results in Family Medicine Offices

Abstract

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...

Patient perspectives on test result communication in primary care: a qualitative study

“…As a consequence, there is significant potential for mistakes throughout the process, from ordering and implementing tests, to relaying results to clinicians and notifying patients. 2 Over the past decade, research undertaken predominantly in the US has recognised growing concerns among physicians in general practice about testing and result management, including the lack of defined administrative procedures and the frequency of delays in the process. 4,5 Recommendations have begun to emerge, outlining areas where the process can be improved and standardised.…”

Evaluating the Connections Between Primary Care Practice and Clinical Laboratory Testing: A Review of the Literature and Call for Laboratory Involvement in the Solutions

“…First, some practices demonstrated a complete lack of a process for ordering, implementing, and reporting laboratory results. Elder et al 24 observed 2 primary care practices that had no written protocols or procedures for any results management steps. Similarly, Pace et al 25 also determined that a total lack of a process system was associated with laboratory errors and a frequent contributor to patient harm.…”

“…Hickner et al 27 reported that errors in laboratory test implementation were nearly double for minority groups compared with Breakdowns in process [24][25][26][27][28][29][30] Practice protocols should include an outlined procedure for laboratory test ordering, reporting of results, and patient notification. Delays in diagnosis 12,25,27,31 Laboratory results should be communicated to patients within 1 business day of receipt by the practice.…”

“…Errors in judgment and cognition 12,25 Primary care providers should have convenient access to laboratory physicians to assist in laboratory test ordering and interpretation. Influence of minorities and speech barriers 24,32 Additional study and root-cause analysis is required. Practice culture 24,32 Indirect measures include the presence of a quality improvement program, monthly quality conference, procedures on how to handle errors, and the presence of an error tracking system.…”

In This Issue: Systematic Strategies and Individualized Approaches to Care

“…3,4 In a qualitative analysis, Elder et al studied the management of test results in 4 separate practices. 5 They note wide variability in the establishment of, and adherence to, systems for results management. Even so, they identify safety awareness and technological adoption as themes that may guide practices in assessing processes for results management.…”