Thursday, April 28, 2005

Errors in the Testing Process in Primary Care: A Report from the American Academy of Family Physicians' National Research Network

Nancy C. Elder, John Hickner, Deborah Graham, Elias Brandt, Susan Dovey, and Robert Phillips.

In primary care, the pre-analytic tasks of the testing process include ordering and implementation and post-analytic tasks include tracking and return, response and documentation, patient notification, and follow up. Errors occurring in these steps have not been well described

To describe the types and frequencies of test processing errors reported by family physicians and staff.

Design: Descriptive study of testing process error reports.
Setting: Eight family practices of the American Academy of Family Physician's National Research Network.
Participants: Physicians, residents, nurse practitioners (NPs), physician's assistants (PAs), nurses and staff.
Main outcome measures: Reports of testing process events described as “anything that happened in my practice that I do not want to happen again.” The reports also included information about harm and consequences

661 events were reported, 41% by physicians and residents, 52% by staff and nurses and 7% by NPs and PAs. To date we have analyzed 273 events in which 433 separate errors were coded.
Over half of the errors could be classified into pre- and post-analytic tasks (ordering (90), tracking and return (78), response and documentation (34) and patient notification (33)). Seventy-seven errors related to charting and filing, and 20 were computer errors. The remaining errors included a number of communication, knowledge and treatment errors. Harm could not be determined in 69 reports, but of the rest, most (139) did not lead to patient harm. However, adverse patient consequences reported included delay in care (47) and time (37), emotional (20), physical (15) and financial (4) problems for patients. In addition physicians and healthcare suffered time, emotional and financial consequences in 82 reported events.

This preliminary analysis reveals that errors are occurring throughout the spectrum of pre- and post-analytic tasks. While significant physical harm was rare, consequences for patients and physicians' offices were common.

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