Related Experiment Video
Updated: Mar 29, 2026
Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes
Published on: March 22, 2022
System hazards in managing laboratory test requests and results in primary care: medical protection database analysis
Paul Bowie1, Julie Price2, Neil Hepworth2
1Department of Medicine, NHS Education for Scotland, Glasgow, UK Institute of Health and Wellbeing, University of Glasgow, UK.
Objectives:
To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards.
Design:
A retrospective database analysis.
Setting:
General practices in the UK and Ireland.
Participants:
778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014.
Main Outcome Measures:
Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance.
Results:
CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the 'postanalytical test stage' (n=702, 43.8%), followed closely by 'communication outcomes issues' (n=628, 39.1%).
Conclusions:
Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems.
Related Concept Videos
01:25Errors occurring during blood pressure monitoring
Several factors...
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:11Assessing Blood pressure in the Leg
Preparation:
01:19Guidelines For Measuring Vital Signs
Before taking a patient's vital signs, a nurse would consider and assess the patient's comfort level and ensure appropriate equipment is available.
01:18Guidelines and Strategies for Safe Computer Charting
Maintain Confidentiality and Security:
01:02Sample Handling
Samples should be transported carefully from collection points to the laboratory. They should be properly sealed and clearly labeled to prevent cross-contamination. To preserve the sample integrity, optimal temperature conditions during transport are essential. This could involve using...